A New Surveillance Algorithm After Resection of Colorectal Liver Metastases Based on Changes in Recurrence Risk and RAS Mutation Status

Background: The optimal surveillance strategy after resection of colorectal liver metastases (CLM) is unknown. We evaluated changes in recurrence risk after CLM resection and developed a surveillance algorithm. Methods: Patients undergoing CLM resection during 1998 to 2015 were identified from a prospectively compiled database and analyzed if they had the potential for follow-up longer than the longest observed time to recurrence in this cohort. Changes in recurrence risk and risk factors for recurrence were evaluated. All statistical tests were 2-sided. Results: Among 2,105 patients who were initially identified and underwent CLM resection, the latest recurrence was observed at 87 months; 1,221 consecutive patients from 1998 through 2011 with the potential for at least 87 months of follow-up were included. The risk of recurrence was highest at 0 to 2 years after CLM resection, lower at 2 to 4 years after CLM resection, and steadily lower after 4 years after CLM resection. Factors associated with increased recurrence risk at the time of surgery were primary lymph node metastasis (hazard ratio [HR], 1.54; 95% CI, 1.21–1.97; P<.001), multiple CLM (HR, 1.31; 95% CI, 1.06–1.63; P=.015), largest liver metastasis diameter >5 cm (HR, 1.64; 95% CI, 1.23–2.19; P<.001), and RAS mutation (HR, 1.29; 95% CI, 1.04–1.59; P=.020). In patients without recurrence at 2 years, the only factor still associated with increased recurrence risk was RAS mutation. In those patients, the recurrence rate at 4 years was 59.3% in patients with RAS mutation versus 27.8% in patients with RAS wild-type (P=.019). Conclusions: For patients who have undergone CLM resection, we propose surveillance every 3 to 4 months during years 0 to 2, every 3 to 4 months (if mutant RAS) versus every 4 to 6 months (if RAS wild-type) during years 2 to 4, and every 6 to 12 months if recurrence-free at 4 years.

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Colorectal Liver Metastases - Does the Number of Lesions Determine the Sensibility of Resection?

Swiss Surgery ◽

10.1024/1023-9332.6.1.6 ◽

2000 ◽

Vol 6 (1) ◽

pp. 6-10

Author(s):

Knoefel ◽

Brunken ◽

Neumann ◽

Gundlach ◽

Rogiers ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Rank Test ◽

Log Rank Test ◽

Kaplan Meier ◽

Chirurgische Entfernung

Die komplette chirurgische Entfernung von Lebermetastasen bietet Patienten nach kolorektalem Karzinom die einzige kurative Chance. Es gibt jedoch eine, anscheinend unbegrenzte, Anzahl an Parametern, die die Prognose dieser Patienten bestimmen und damit den Sinn dieser Therapie vorhersagen können. Zu den am häufigsten diskutierten und am einfachsten zu bestimmenden Parametern gehört die Anzahl der Metastasen. Ziel dieser Studie war es daher die Wertigkeit dieses Parameters in der Literatur zu reflektieren und unsere eigenen Patientendaten zu evaluieren. Insgesamt konnte von 302 Patienten ein komplettes Follow-up erhoben werden. Die gebildeten Patientengruppen wurden mit Hilfe einer Kaplan Meier Analyse und konsekutivem log rank Test untersucht. Die Literatur wurde bis Dezember 1998 revidiert. Die Anzahl der Metastasen bestätigte sich als ein prognostisches Kriterium. Lagen drei oder mehr Metastasen vor, so war nicht nur die Wahrscheinlichkeit einer R0 Resektion deutlich geringer (17.8% versus 67.2%) sondern auch das Überleben der Patienten nach einer R0 Resektion tendenziell unwahrscheinlicher. Das 5-Jahres Überleben betrug bei > 2 Metastasen 9% bei > 2 Metastasen 36%. Das 10-Jahres Überleben beträgt bislang bei > 2 Metastasen 0% bei > 2 Metastasen 18% (p < 0.07). Die Anzahl der Metastasen spielt in der Prognose der Patienten mit kolorektalen Lebermetastasen eine Rolle. Selbst bei mehr als vier Metastasen ist jedoch gelegentlich eine R0 Resektion möglich. In diesen Fällen kann der Patient auch langfristig von einer Operation profitieren. Das wichtigere Kriterium einer onkologisch sinnvollen Resektabilität ist die Frage ob technisch und funktionell eine R0 Resektion durchführbar ist. Ist das der Fall, so sollte auch einem Patienten mit mehreren Metastasen die einzige kurative Chance einer Resektion nicht vorenthalten bleiben.

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Percutaneous microwave ablation combined with synchronous transcatheter arterial chemoembolization for the treatment of colorectal liver metastases: results from a follow-up cohort

OncoTargets and Therapy ◽

10.2147/ott.s105192 ◽

2016 ◽

pp. 3783 ◽

Cited By ~ 7

Author(s):

Zengbao Wu ◽

Zeng-Mei Si ◽

Sheng Qian ◽

Ling-Xiao Liu ◽

Xu-Dong Qu ◽

...

Keyword(s):

Liver Metastases ◽

Microwave Ablation ◽

Colorectal Liver Metastases ◽

Transcatheter Arterial Chemoembolization ◽

Percutaneous Microwave Ablation ◽

Arterial Chemoembolization

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Recurrence risk factors in detachable balloon embolization of traumatic direct carotid cavernous fistulas in 188 patients

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013384 ◽

2017 ◽

Vol 10 (7) ◽

pp. 704-707 ◽

Cited By ~ 2

Author(s):

Bu-Lang Gao ◽

Zi-Liang Wang ◽

Tian-Xiao Li ◽

Bin Xu

Keyword(s):

Risk Factors ◽

Recurrence Risk ◽

Parent Artery ◽

Nerve Paralysis ◽

Factors Affecting ◽

Risk Factors For Recurrence ◽

Carotid Cavernous Fistulas ◽

Abducent Nerve ◽

Balloon Embolization

PurposeTo investigate the effects of detachable balloons in embolizing traumatic carotid cavernous fistulas (TCCFs) and the risk factors for recurrence after balloon embolization.Materials and methods188 patients with TCCFs were enrolled, and clinical, treatment, and follow-up data were analyzed for possible risk factors for recurrence after embolization.ResultsAmong 188 patients, 182 (96.8%) had successful balloon embolization; 6 patients failed. One balloon was used in 94 cases and multiple (two or more) balloons were used in 62 patients. 26 patients had occlusion of the parent artery whereas the remainder had parent artery preservation. Periprocedural complications occurred in 3 patients (1.6%) including cerebral embolism in 1 and abducent nerve paralysis in the other 2. Immediately following embolization, headache appeared in 92 patients and was relieved after 3–5 days with medications. A total of 165 patients (87.8%) had follow-up (6 months to 16 years, mean 5 years). 23 (13.9%) patients with internal carotid artery preservation had recurrence 1–33 days (mean 11 days) after the first embolization and were retreated to complete occlusion. Factors affecting recurrence were multiple balloons and residual fistula (p<0.05). Logistic regression confirmed the independent factors affecting recurrence were multiple balloons (≥2 balloons, OR 7.80, 95% CI 2.28 to 26.73; p=0.001) and residual fistula immediately following embolization (OR 10.46, 95% CI 2.99 to 36.5; p=0.000).ConclusionThe recurrence rate is high in the first month after embolization with detachable balloons, and multiple balloons and residual fistula are two independent factors affecting recurrence following balloon embolization.

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Invited Commentary to: Costs and Efficiency of a Tumour Follow-up Program for the detection of Colorectal Liver Metastases

European Surgery ◽

10.1046/j.1563-2563.2001.01002.x ◽

2001 ◽

Vol 33 (1) ◽

pp. 42-42 ◽

Cited By ~ 1

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases

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Perioperative Blood Transfusions are Associated with Decreased Time to Recurrence and Decreased Survival after Resection of Colorectal Liver Metastases

Annals of Surgery ◽

10.1097/00000658-198812000-00002 ◽

1988 ◽

Vol 208 (6) ◽

pp. 679-687 ◽

Cited By ~ 179

Author(s):

KEITH R. STEPHENSON ◽

SETH M. STEINBERG ◽

KEVIN S. HUGHES ◽

JOHN T. VETTO ◽

PAUL H. SUGARBAKER ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Blood Transfusions ◽

Time To Recurrence

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Prospective Evaluation of Intrahepatic Microscopic Occult Tumor Foci in Patients with Numerous Colorectal Liver Metastases

Digestive Surgery ◽

10.1159/000489274 ◽

2018 ◽

Vol 36 (4) ◽

pp. 340-347 ◽

Cited By ~ 1

Author(s):

Luca Vigano ◽

Luca Di Tommaso ◽

Antonio Mimmo ◽

Mauro Sollai ◽

Matteo Cimino ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Intraoperative Imaging ◽

Median Number ◽

Early Recurrence ◽

Resected Specimen ◽

Lesion Analysis ◽

Healthy Liver ◽

Disease Free

Background: Patients with numerous colorectal liver metastases (CLM) have high risk of early recurrence after liver resection (LR). The presence of intrahepatic occult microscopic metastases missed by imaging has been hypothesized, but it has never been assessed by pathology analyses. Methods: All patients with > 10 CLM who underwent LR between September 2015 and September 2016 were considered. A large sample of liver without evidence of disease (“healthy liver”) was taken from the resected specimen and sent to the pathologist. One mm-thick sections were analyzed. Any metastasis, undetected by preoperative and intraoperative imaging, but identified by the pathologist was classified as occult microscopic metastasis. Results: Ten patients were prospectively enrolled (median number of CLM n = 15). In a per-lesion analysis, the sensitivity of computed tomography and magnetic resonance imaging was 91 and 98% respectively. The pathology examination confirmed all the CLM. All patients had an adequate sample of “healthy liver” (median number of examined blocks per sample n = 14 [5–33]). No occult microscopic metastases were detected. After a median follow-up of 15 months, 5 patients were disease-free. Recurrence was hepatic and bilobar in all patients. Conclusions: Clinically relevant occult microscopic disease in patients with numerous CLM is excluded. These results support the indication to resection in such patients and exclude the need for de principe major hepatectomy to increase the completeness of surgery.

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