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Simsek M, Besiroglu M, Akcakaya A, Topcu A, Yasin AI, Isleyen ZS, Seker M, Turk HM. Local interventions for colorectal cancer metastases to liver and lung. Ir J Med Sci 2023; 192:2635-2641. [PMID: 36929352 DOI: 10.1007/s11845-023-03340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Colorectal cancer is a common cause of cancer-related deaths. About 1/3 of all cases present with distant metastasis, with the liver as the leading site and the lung as the most common extra-abdominal site. AIMS It was aimed to evaluate the clinical characteristics and the outcomes of colorectal cancer patients with liver or lung metastasis who had received local treatments. METHODS This is a retrospective, cross-sectional, and descriptive study. The study was performed with colorectal cancer patients that referred to the medical oncology clinic of a university hospital between December 2013 and August 2021. RESULTS A total number of 122 patients who have received local treatments were included. Radiofrequency ablation was applied in 32 patients (26.2%), metastasis was surgically resected in 84 patients (68.9%), and stereotactic body radiotherapy was preferred in six patients (4.9%). At the first follow-up control after completion of local or multimodal treatment, no residual tumor was determined with radiological assessment in 88 patients (72.1%). The median progression-free survival (16.7 months vs 9.7 months) (p = .000) and the median overall survival (37.3 months vs 25.5 months) (p = .004) of these patients were significantly better than the patients with residual disease. CONCLUSIONS Local interventions that are applied to highly selected patients may improve the survival of metastatic colorectal cancer patients. A close follow-up after local therapies is important to diagnose recurrent disease because repeated local interventions may be possible to achieve better outcomes.
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Affiliation(s)
- Melih Simsek
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey.
| | - Mehmet Besiroglu
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Adem Akcakaya
- Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Atakan Topcu
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ayse Irem Yasin
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Zehra Sucuoglu Isleyen
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Mesut Seker
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Haci Mehmet Turk
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
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2
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Zhu HB, Xu D, Sun XF, Li XT, Zhang XY, Wang K, Xing BC, Sun YS. Prediction of hepatic lymph node metastases based on magnetic resonance imaging before and after preoperative chemotherapy in patients with colorectal liver metastases underwent surgical resection. Cancer Imaging 2023; 23:18. [PMID: 36810192 PMCID: PMC9942330 DOI: 10.1186/s40644-023-00529-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Patients with colorectal liver metastases (CRLM) combined with hepatic lymph node (HLN) metastases have a poor prognosis. In this study, we developed and validated a model using clinical and magnetic resonance imaging (MRI) parameters to predict HLN status before surgery. METHODS A total of 104 CRLM patients undergoing hepatic lymphonodectomy with pathologically confirmed HLN status after preoperative chemotherapy were enrolled in this study. The patients were further divided into a training group (n = 52) and a validation group (n = 52). The apparent diffusion coefficient (ADC) values, including ADCmean and ADCmin of the largest HLN before and after treatment, were measured. rADC was calculated referring to the target liver metastases, spleen, and psoas major muscle (rADC-LM, rADC-SP, rADC-m). In addition, ADC change rate (Δ% ADC) was quantitatively calculated. A multivariate logistic regression model for predicting HLN status in CRLM patients was constructed using the training group and further tested in the validation group. RESULTS In the training cohort, post-ADCmean (P = 0.018) and the short diameter of the largest lymph node after treatment (P = 0.001) were independent predictors for metastatic HLN in CRLM patients. The model's AUC was 0.859 (95% CI, 0.757-0.961) and 0.767 (95% CI 0.634-0.900) in the training and validation cohorts, respectively. Patients with metastatic HLN showed significantly worse overall survival (p = 0.035) and recurrence-free survival (p = 0.015) than patients with negative HLN. CONCLUSIONS The developed model using MRI parameters could accurately predict HLN metastases in CRLM patients and could be used to preoperatively assess the HLN status and facilitate surgical treatment decisions in patients with CRLM.
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Affiliation(s)
- Hai-bin Zhu
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
| | - Da Xu
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
| | - Xue-Feng Sun
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
| | - Xiao-Ting Li
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
| | - Xiao-Yan Zhang
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
| | - Kun Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
| | - Bao-Cai Xing
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
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3
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Cassar N, Geoghegan J, Hoti E. Shifting concepts in the management of colorectal liver metastases. Surgeon 2022; 20:363-372. [PMID: 34998701 DOI: 10.1016/j.surge.2021.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/21/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023]
Abstract
Management of patients with colorectal liver metastases has evolved considerably due to a better understanding of the biology of the disease with concurrent improvements in surgical techniques, oncological strategies and radiological interventions. This review article examines the factors that have contributed to this radical change. Management will be discussed in relation to chemotherapy, surgery and interventional radiology. The addition of chemotherapy and biological agents has greatly extended the reach and scope of surgery. Parenchymal sparing resections, repeat resections, two stage hepatectomy and Associating Liver Partition and Portal Vein ligation are all available to the hepatobiliary surgeon who deals with colorectal liver metastases. Interventional radiology techniques like liver venous deprivation may also replace established surgical practice. Whilst traditionally it was thought that only a few liver metastases could be treated effectively, nowadays tumour number is no longer a limiting factor provided enough functioning liver can be spared and the patient can tolerate the operation.
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Affiliation(s)
- Noel Cassar
- Department of Hepatobiliary Surgery and Liver Transplantation, St Vincent's University Hospital, Elm Park, Dublin 4 D04 T6F4, Ireland.
| | - Justin Geoghegan
- Department of Hepatobiliary Surgery and Liver Transplantation, St Vincent's University Hospital, Elm Park, Dublin 4 D04 T6F4, Ireland
| | - Emir Hoti
- Department of Hepatobiliary Surgery and Liver Transplantation, St Vincent's University Hospital, Elm Park, Dublin 4 D04 T6F4, Ireland
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4
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Primary Tumor Location Is a Prognostic Factor for Intrahepatic Progression-Free Survival in Patients with Colorectal Liver Metastases Undergoing Portal Vein Embolization as Preparation for Major Hepatic Surgery. Cancers (Basel) 2020; 12:cancers12061638. [PMID: 32575781 PMCID: PMC7352622 DOI: 10.3390/cancers12061638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/29/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to identify prognostic factors affecting intrahepatic progression-free survival (ihPFS) and overall survival (OS) in patients with colorectal cancer liver metastases (CRCLM) undergoing portal vein embolization (PVE) and subsequent (extended) right hemihepatectomy. A total of 59 patients (mean age: 60.8 ± 9.3 years) with CRCLM who underwent PVE in preparation for right hemihepatectomy were included. IhPFS and OS after PVE were calculated using the Kaplan–Meier method. Cox regression analyses were conducted to investigate the association between the following factors and survival: patient age, laterality of the colorectal cancer (right- versus left-sided), tumor location (colon versus rectal cancer), time of occurrence of hepatic metastases (synchronous versus metachronous), baseline number and size of hepatic metastases, presence or absence of metastases in the future liver remnant (FLR) before PVE, preoperative carcinoembryogenic antigen (CEA) levels, time between PVE and surgery, history of neoadjuvant or adjuvant chemotherapy, and the presence or absence of extrahepatic disease before PVE. Median follow up was 18 months. The median ihPFS was 8.2 months (95% confidence interval: 6.2–10.2 months), and median OS was 34.1 months (95% confidence interval: 27.3–40.9 months). Laterality of the primary colorectal cancer was the only statistically significant predictor of ihPFS after PVE (hazard ratio (HR) = 2.242; 95% confidence interval: 1.125, 4.465; p = 0.022), with patients with right-sided colorectal cancer having significantly shorter median ihPFS than patients with left-sided cancer (4.0 ± 1.9 months versus 10.2 ± 1.5 months; log rank test: p = 0.018). Other factors, in particular also the presence or absence of additional metastases in the FLR, were not associated with intrahepatic progression-free survival. The presence of extrahepatic disease was associated with worse OS (HR = 3.050, 95% confidence interval: 1.247, 7.459; p = 0.015).
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5
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Diffusion-weighted imaging and loco-regional N staging of patients with colorectal liver metastases. Eur J Surg Oncol 2019; 45:347-352. [DOI: 10.1016/j.ejso.2018.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 11/19/2018] [Accepted: 11/23/2018] [Indexed: 12/27/2022] Open
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6
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Yeatman TJ, Yang M, Coppola D. Whole Genome Sequencing Analysis of a Stage IV Colon Cancer Patient with a 10-Year Disease-Free Survival following Systemic Chemotherapy/Bevacizumab. Case Rep Gastroenterol 2018; 12:729-736. [PMID: 30631260 PMCID: PMC6323361 DOI: 10.1159/000494751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/15/2018] [Indexed: 12/14/2022] Open
Abstract
It is rare that stage IV colon cancer is cured with chemotherapy. Here we report the long-term survival of a patient who presented with highly advanced disease characterized by a papillary architecture as well as porta hepatis lymph nodes but responded extremely well to FOLFIRI/bevacizumab. His original tumor underwent comprehensive genomic testing that included whole genome DNA sequencing, targeted sequencing, and RNA sequencing. These genetic results suggest the patient's tumor harbored mutations in APC, KRAS, and TP53 as well as in PIK3CB. Moreover, the RNA-seq data suggested that the tumor belonged to the consensus molecular subtype 4, the "inflamed, immune phenotype," with increased angiogenesis. Deep sequencing of highly responsive cancers may yield molecular insights into mechanisms underpinning a remarkable response.
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Affiliation(s)
- Timothy J. Yeatman
- Gibbs Cancer Center & Research Institute, Spartanburg, South Carolina, USA
| | - Mingli Yang
- Gibbs Cancer Center & Research Institute, Spartanburg, South Carolina, USA
| | - Domenico Coppola
- Department of Anatomic Pathology, Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
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7
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Okuno M, Goumard C, Mizuno T, Kopetz S, Omichi K, Tzeng CWD, Chun YS, Lee JE, Vauthey JN, Conrad C. Prognostic impact of perihepatic lymph node metastases in patients with resectable colorectal liver metastases. Br J Surg 2018; 105:1200-1209. [PMID: 29664996 DOI: 10.1002/bjs.10822] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although perihepatic lymph node metastases (PLNMs) are known to be a poor prognosticator for patients with colorectal liver metastases (CRLMs), optimal management remains unclear. This study aimed to determine the risk factors for PLNMs, and the survival impact of their number and location in patients with resectable CRLMs. METHODS Data on patients with CRLM who underwent hepatectomy during 2003-2014 were analysed retrospectively. Recurrence-free (RFS) and overall (OS) survival were calculated according to presence, number and location of PLNMs. Risk factors for PLNM were evaluated by logistic regression analysis. RESULTS Of 1485 patients, 174 underwent lymphadenectomy, and 54 (31·0 per cent) had PLNM. Ten patients (5·7 per cent) who had lymphadenectomy and 176 (13·4 per cent) who did not underwent repeat hepatectomy. Survival of patients with PLNM was significantly poorer than that of patients without (RFS: 5·3 versus 13·8 months, P < 0·001; OS: 20·5 versus 71·3 months; P < 0·001). Median OS was significantly better in patients with para-aortic versus hepatoduodenal ligament PLNMs (58·2 versus 15·5 months; P = 0·011). Patients with three or more PLNMs had significantly worse median OS than those with one or two (16·3 versus 25·4 months; P = 0·039). The presence of primary tumour lymph node metastases (odds ratio 2·35; P = 0·037) and intrahepatic recurrence requiring repeat hepatectomy (odds ratio 5·61; P = 0·012) were significant risk factors for PLNM on multivariable analysis. CONCLUSION Patients undergoing repeat hepatectomy and those with primary tumour lymph node metastases are at significant risk of PLNM. Although PLNM is a poor prognostic factor independent of perihepatic lymph node station, patients with one or two PLNMs have a more favourable outcome than those with more PLNMs.
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Affiliation(s)
- M Okuno
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - C Goumard
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - T Mizuno
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - S Kopetz
- Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - K Omichi
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - C-W D Tzeng
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Y S Chun
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - J E Lee
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - J-N Vauthey
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - C Conrad
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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8
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Perini MV, Tai J, Muralidharan V, Christophi C. Sentinel lymph node mapping in liver resection for colorectal liver metastases. ANZ J Surg 2018; 89:978-980. [DOI: 10.1111/ans.14405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 12/26/2017] [Accepted: 12/29/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Marcos V. Perini
- Hepato‐Pancreato‐Biliary and Transplantation UnitAustin Health Melbourne Victoria Australia
- Department of SurgeryAustin Health, The University of Melbourne Melbourne Victoria Australia
| | - James Tai
- Hepato‐Pancreato‐Biliary and Transplantation UnitAustin Health Melbourne Victoria Australia
- Department of SurgeryAustin Health, The University of Melbourne Melbourne Victoria Australia
| | - Vijayaragavan Muralidharan
- Hepato‐Pancreato‐Biliary and Transplantation UnitAustin Health Melbourne Victoria Australia
- Department of SurgeryAustin Health, The University of Melbourne Melbourne Victoria Australia
| | - Christopher Christophi
- Hepato‐Pancreato‐Biliary and Transplantation UnitAustin Health Melbourne Victoria Australia
- Department of SurgeryAustin Health, The University of Melbourne Melbourne Victoria Australia
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9
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Ushio A, Takauchi K, Kobayashi M, Abe N, Sumida H, Nagata Y, Awai K. [Differentiation between Hepatic Focal Lesions and Heterogenous Physiological Accumulations by Early Delayed Scanning in 18F-FDG PET/CT Examination]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:556-562. [PMID: 29925750 DOI: 10.6009/jjrt.2018_jsrt_74.6.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE We examined whether early delayed scanning is useful for differentiation of liver lesion and heterogenous physiological accumulation in positron emission tomography (PET) examination. METHODS The subjects of the study were 33 patients with colorectal cancer who underwent PET examination and were added early delayed scanning to distinguish between liver lesions and heterogenous physiological accumulation to conventional early images. We placed same regions of interest (ROI) in the tumor and hepatic parenchyma for early delayed and conventional early images. Then, we measured SUVmax of the ROIs and calculated tumor to liver parenchyma uptake ratio (TLR). In addition, change rates between early and early delayed images were calculated for the SUVmax and TLR. RESULTS The receiver operating characterstic (ROC) analysis result of SUVmax showed the highest SUVmax change rate, and the ROC analysis result of TLR showed the highest early delayed scanning. The SUVmax of the lesions did not change between early scan and early delayed scanning (p=0.98), but it decreased significantly in the normal group (p<0.001). TLR of the lesion group was significantly increased (p<0.001) in early delayed images compared to early scan and TLR significantly decreased in the normal group (p<0.001). The AUC of the ROC curve showed the highest SUVmax change rate (0.99). CONCLUSION Early delayed scanning could distinguish between liver lesions and heterogenous physiological accumulation in colon cancer patients.
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Affiliation(s)
- Ayaka Ushio
- Department of Radiology, Hiroshima University Hospital
| | | | | | - Nobukazu Abe
- Department of Radiology, Hiroshima University Hospital
| | | | - Yasushi Nagata
- Department of Radiation Oncology, Hiroshima University Hospital
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Hospital
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10
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Baek JH, Kim KK, Lee JN, Ha SY, Lee WK, Lee WS. Prophylactic perihepatic lymphadenectomy in patients with colorectal cancer with liver metastasis: A prospective preliminary study. SURGICAL PRACTICE 2017. [DOI: 10.1111/1744-1633.12238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jeong Heum Baek
- Department of Surgery; Gachon University School of Medicine; Incheon Korea
| | - Keon-Kuk Kim
- Department of Surgery; Gachon University School of Medicine; Incheon Korea
| | - Jung-Nam Lee
- Department of Surgery; Gachon University School of Medicine; Incheon Korea
| | - Seung-Yeon Ha
- Department of Surgery; Gachon University School of Medicine; Incheon Korea
- Department of Pathology; Gachon University School of Medicine; Incheon Korea
| | - Woon Kee Lee
- Department of Surgery; Gachon University School of Medicine; Incheon Korea
| | - Won-Suk Lee
- Department of Surgery; Gachon University School of Medicine; Incheon Korea
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11
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Chakedis J, Squires MH, Beal EW, Hughes T, Lewis H, Paredes A, Al-Mansour M, Sun S, Cloyd JM, Pawlik TM. Update on current problems in colorectal liver metastasis. Curr Probl Surg 2017; 54:554-602. [PMID: 29198365 DOI: 10.1067/j.cpsurg.2017.10.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jeffrey Chakedis
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Malcolm H Squires
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Eliza W Beal
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Tasha Hughes
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Heather Lewis
- University of Colorado Health System, Fort Collins, CO
| | - Anghela Paredes
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Mazen Al-Mansour
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Steven Sun
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Jordan M Cloyd
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Timothy M Pawlik
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH.
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12
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Yu J, Chen Y, Wu Y, Ye L, Lian Z, Wei H, Sun R, Tian Z. The differential organogenesis and functionality of two liver-draining lymph nodes in mice. J Autoimmun 2017; 84:109-121. [PMID: 28886898 DOI: 10.1016/j.jaut.2017.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 12/13/2022]
Abstract
The liver is an immunological organ. However, fundamental knowledge concerning liver-draining lymph nodes (LNs), which have been newly identified in mice as the portal and celiac LNs, is still lacking. Here, we revealed that the portal LN and celiac LN drain liver lymph through different lymphatic vessels. Although both the portal LN and celiac LN possess typical structures, they have different cell compositions. Interestingly, these two LNs form at different times during fetal development. Moreover, the organogenesis of the celiac LN, but not the portal LN, is controlled by the transcription factor NFIL3. Furthermore, the portal LN and celiac LN also perform different functions. The celiac LN is the predominant site of liver antiviral immune responses, whereas the portal LN functions in the in situ induction of dietary antigen-specific regulatory T cells. In conclusion, the portal LN and celiac LN are two independent liver-draining LNs with different organogenesis histories and separate functions in maintaining immune homeostasis in the liver.
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Affiliation(s)
- Jiali Yu
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Yongyan Chen
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Yuzhang Wu
- Institute of Immunology, Third Military Medical University, Chongqing, 400038, China.
| | - Lilin Ye
- Institute of Immunology, Third Military Medical University, Chongqing, 400038, China
| | - Zhexiong Lian
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Haiming Wei
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Rui Sun
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Zhigang Tian
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
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13
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Hodgson R, Sethi H, Ling AH, Lodge P. Combined hepatectomy and hepatic pedicle lymphadenectomy in colorectal liver metastases is justified. HPB (Oxford) 2017; 19:525-529. [PMID: 28215513 DOI: 10.1016/j.hpb.2017.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/21/2017] [Accepted: 01/24/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to describe the outcome of patients with colorectal liver metastases (CRLM) and radiological or clinical evidence of metastatic hepatic lymph node involvement who underwent combined hepatectomy and hepatic pedicle lymphadenectomy. METHODS Retrospective analysis of a prospectively maintained audit of 2082 patients undergoing liver resection for CRLM between 1994 and 2014. Age, type of resection, CT/MRI/PET detection, location, disease recurrence and survival were analysed. RESULTS Combined hepatectomy and hepatic pedicle lymphadenopathy was performed on 76 patients who met the inclusion criteria. 46% of enlarged lymph nodes were located in the hepatic ligament, with 38% retroportal, 38% common hepatic and 33% coeliac nodes. 50% of lymph node resections were positive for metastatic tumour. Pre-operative CT, MRI and CT/PET failed to detect histologically proven lymph node disease in 25/38 patients. Patients with negative nodal histology had a significant overall (44 vs 20 months, p = 0.008) and disease free (20 vs 11 months, p < 0.001) survival advantage. CONCLUSION Combined hepatectomy and lymph node resection for CRLM in the setting of enlarged or suspicious lymphadenopathy is justified as imaging and operative findings are poor guides in determining positive lymph node disease.
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Affiliation(s)
- Russell Hodgson
- St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK.
| | - Harsheet Sethi
- St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK
| | - Andrew H Ling
- St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK
| | - Peter Lodge
- St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK
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Pindak D, Pavlendova J, Tomas M, Dolnik J, Duchon R, Pechan J. Selective versus routine lymphadenectomy in the treatment of liver metastasis from colorectal cancer: a retrospective cohort study. BMC Surg 2017; 17:34. [PMID: 28376753 PMCID: PMC5381135 DOI: 10.1186/s12893-017-0233-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/31/2017] [Indexed: 11/10/2022] Open
Abstract
Background Limited data are available on the importance of routine lymphadenectomy of the hepatoduodenal ligament in the treatment of liver metastasis from colorectal cancer in the literature. Methods A single center retrospective cohort study was conducted to evaluate morbidity and long-term survival in patients who had undergone selective versus routine lymphadenectomy during surgery for colorectal liver metastasis. From January 2006 to December 2009, eighty-one patients undergoing radical resection due to liver metastasis from colorectal cancer were included. The combination of two surgical teams with different approaches to hepatoduodenal ligament lymphadenectomy at our institution allowed us to select two cohorts of patients undergoing selective or routine lymphadenectomy. Results No significant differences between the cohorts were found in age, American Society of Anesthesiology score or Fong’s prognostic criteria. Patients with pN+ disease had significantly inferior survival compared to patients with pN0 disease (hazard ratio [HR] = 6.33, 95% CI 2.16–18.57, p = 0.0001). No significant difference in postoperative morbidity was observed in the group undergoing routine opposed to selective lymphadenectomy (13.63% vs. 8.69%, p = 0.36). There was no difference in long-term survival between the groups (HR = 0.90, 95% CI 0.52–1.58, p = 0.70). There were also no significant differences in the subgroup of patients with pN0 stage (HR = 1.17, 95% CI 0.6–2.11, p = 0.60). Conclusions These data suggest that there is no survival benefit from the use of routine lymphadenectomy during surgery for colorectal liver metastasis, but these data should be confirmed in a prospective randomized study.
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Affiliation(s)
- Daniel Pindak
- Department of Surgical Oncology, Slovak Medical University, Bratislava, Slovakia. .,National Cancer Institute, Klenova 1, 833 10, Bratislava 3, Slovakia.
| | - Jana Pavlendova
- Department of Surgical Oncology, Slovak Medical University, Bratislava, Slovakia.,National Cancer Institute, Klenova 1, 833 10, Bratislava 3, Slovakia
| | - Miroslav Tomas
- Department of Surgical Oncology, Slovak Medical University, Bratislava, Slovakia.,National Cancer Institute, Klenova 1, 833 10, Bratislava 3, Slovakia
| | - Jozef Dolnik
- National Cancer Institute, Klenova 1, 833 10, Bratislava 3, Slovakia
| | - Robert Duchon
- National Cancer Institute, Klenova 1, 833 10, Bratislava 3, Slovakia
| | - Juraj Pechan
- Department of Surgical Oncology, Slovak Medical University, Bratislava, Slovakia.,National Cancer Institute, Klenova 1, 833 10, Bratislava 3, Slovakia
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15
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Nanji S, Tsang ME, Wei X, Booth CM. Regional lymph node involvement in patients undergoing liver resection for colorectal cancer metastases. Eur J Surg Oncol 2016; 43:322-329. [PMID: 28057391 DOI: 10.1016/j.ejso.2016.10.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/08/2016] [Accepted: 10/07/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While the indications for surgery among patients with colorectal cancer liver metastases (CRCLM) are expanding, the role of surgery in patients with hepatic lymph node involvement remains controversial. We report management and outcomes in a population-based cohort of patients undergoing hepatectomy with concomitant hepatic lymphadenectomy for CRCLM. METHODS All cases of hepatectomy for CRCLM in the Canadian Province of Ontario from 2002 to 2009 were identified using the population-based Ontario Cancer Registry and linked electronic records of treatment. Pathology reports were used to identify concomitant lymphadenectomy with liver resection as well as extent of disease and surgical procedure. RESULTS Among 1310 patients who underwent resection for CRCLM, 103 (8%) underwent simultaneous regional lymphadenectomy. Seventy-one percent of cases with lymphadenectomy (70/103) had a major liver resection (≥3 segments). Of the 103 lymphadenectomy cases, 80 (78%) were hepatic pedicle, 16 (16%) were celiac and 7 (7%) were para-aortic. The mean number of nodes removed was 2.2 (range 1-15). Ninety-day mortality was 6%. Twenty-nine percent (30/103) of cases had positive nodes. Unadjusted overall survival at 5 years for positive vs negative nodes was 21% vs 42% (p = 0.003); cancer-specific survival was 10% vs 43% (p < 0.001). In adjusted analyses, hepatic node involvement was associated with inferior OS (HR 2.19, p = 0.010) and CSS (HR 3.07, p = 0.002). CONCLUSIONS Patients with resected CRC liver metastases with regional lymph node involvement have inferior survival compared to patients with negative nodes. Despite this poor prognostic factor, a small proportion of cases with involved nodes will achieve long-term survival.
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Affiliation(s)
- S Nanji
- Department of Surgery, Queen's University, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada.
| | - M E Tsang
- Department of Surgery, St. Joseph's Hospital, Toronto, Ontario, Canada
| | - X Wei
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - C M Booth
- Department of Oncology, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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Andres A, Majno P, Terraz S, Morel P, Roth A, Rubbia-Brandt L, Schiffer E, Ris F, Toso C. Management of patients with colorectal liver metastasis in eleven questions and answers. Expert Rev Anticancer Ther 2016; 16:1277-1290. [PMID: 27744725 DOI: 10.1080/14737140.2016.1249855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Colorectal liver metastasis (CRLM) is the most frequent indication for liver resection in many centers. Recent improvements in oncology, surgery, interventional radiology, pathology and anesthesiology allow curative treatment in a larger proportion of patients with CRLM. Areas covered: We illustrate the various aspects of the management of CRLM through 11 questions that summarize the topic, from the current obtained survival to future perspectives such as transplantation. The limits of a curative treatment are also presented from different angles, such as the benefits of pathology, the surgical options for extreme resections, the available chemotherapies and their efficacy, or the non-surgical ablative treatments. Expert commentary: Given the increasing therapeutic possibilities, we strengthen the importance to analyze the situation of each patient with CRLM in a dedicated multidisciplinary team, in order to offer the best individualized treatment combination.
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Affiliation(s)
- Axel Andres
- a Faculty of Medicine, Hepato-Pancreato-Biliary Centre , Geneva University Hospital , Geneva , Switzerland.,b Faculty of Medicine, Division of Abdominal Surgery , Geneva University Hospital , Geneva , Switzerland
| | - Pietro Majno
- a Faculty of Medicine, Hepato-Pancreato-Biliary Centre , Geneva University Hospital , Geneva , Switzerland.,b Faculty of Medicine, Division of Abdominal Surgery , Geneva University Hospital , Geneva , Switzerland
| | - Sylvain Terraz
- a Faculty of Medicine, Hepato-Pancreato-Biliary Centre , Geneva University Hospital , Geneva , Switzerland.,c Faculty of Medicine, Division of Radiology , Geneva University Hospital , Geneva , Switzerland
| | - Philippe Morel
- a Faculty of Medicine, Hepato-Pancreato-Biliary Centre , Geneva University Hospital , Geneva , Switzerland.,b Faculty of Medicine, Division of Abdominal Surgery , Geneva University Hospital , Geneva , Switzerland
| | - Arnaud Roth
- a Faculty of Medicine, Hepato-Pancreato-Biliary Centre , Geneva University Hospital , Geneva , Switzerland.,d Faculty of Medicine, Division of Oncology , Geneva University Hospital , Geneva , Switzerland
| | - Laura Rubbia-Brandt
- a Faculty of Medicine, Hepato-Pancreato-Biliary Centre , Geneva University Hospital , Geneva , Switzerland.,e Faculty of Medicine, Division of Clinical Pathology , Geneva University Hospital , Geneva , Switzerland
| | - Eduardo Schiffer
- a Faculty of Medicine, Hepato-Pancreato-Biliary Centre , Geneva University Hospital , Geneva , Switzerland.,f Faculty of Medicine, Division of Anesthesiology , Geneva University Hospital , Geneva , Switzerland
| | - Frederic Ris
- b Faculty of Medicine, Division of Abdominal Surgery , Geneva University Hospital , Geneva , Switzerland
| | - Christian Toso
- a Faculty of Medicine, Hepato-Pancreato-Biliary Centre , Geneva University Hospital , Geneva , Switzerland.,b Faculty of Medicine, Division of Abdominal Surgery , Geneva University Hospital , Geneva , Switzerland
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Yong TL, Houli N, Christophi C. Anatomy of hepatic lymphatics and its implications in hepatic malignancies. ANZ J Surg 2016; 86:868-873. [DOI: 10.1111/ans.13662] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/19/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Tuck Leong Yong
- Department of Surgery; Northern Health; Melbourne Victoria Australia
| | - Nezor Houli
- Department of Surgery; Northern Health; Melbourne Victoria Australia
| | - Chris Christophi
- Department of Surgery; Austin Health; Melbourne Victoria Australia
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18
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Hepatic Resection for Extrahepatic Metastatic Disease: When Is It Reasonable? CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-015-0263-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Bredt LC, Rachid AF. Predictors of recurrence after a first hepatectomy for colorectal cancer liver metastases: a retrospective analysis. World J Surg Oncol 2014; 12:391. [PMID: 25528650 PMCID: PMC4364583 DOI: 10.1186/1477-7819-12-391] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 12/03/2014] [Indexed: 02/08/2023] Open
Abstract
Background Surgical resection is considered the standard therapy in the treatment of liver metastases from colorectal cancer (CRCLM); however, most patients experience tumor recurrence after curative hepatic resection. The objective was to determine potential prognostic factors for tumor recurrence after an initial hepatectomy for CRCLM. Methods A study population of 101 patients who had undergone a first curative hepatectomy for CRCLM was retrospectively analyzed. Selected biological tumor markers, and clinical and pathological features were then tested by Cox regression. Results Synchronous liver metastases occurred in 38 patients (37.6%) and 63 patients (62.3%) presented with metachronous liver metastases. In a median follow-up time of 68 months, recurrence was observed in 64 patients (63.3%). The 5-year cumulative risk of recurrence was 56.7%. The median survival after recurrence was 24.5 months (range 1 to 41 months) and 5-year cumulative overall survival was 31.8%. Of all variables tested by Cox regression, intra- and extrahepatic resectable disease, CEA levels ≥50 ng/mL and bilobar liver disease remained significant as predictors of recurrence in the multivariate analysis. Conclusions Independent risk factors for recurrence after an initial hepatectomy for CRCLM, such as intra- and extrahepatic resectable disease, CEA levels ≥50 ng/mL and bilobar liver disease, can eventually help in making decisions in this very complex scenario.
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Affiliation(s)
- Luis Cesar Bredt
- Department of Abdominal Surgery, Hepatobiliary Section, Cancer Hospital-UOPECCAN, Cascavel, PR 85812-270, Brazil.
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Lymphatic drainage of the liver and its implications in the management of colorectal cancer liver metastases. Updates Surg 2014; 66:239-45. [PMID: 25168641 DOI: 10.1007/s13304-014-0265-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/22/2014] [Indexed: 12/11/2022]
Abstract
The liver is the most common site of distant metastases in patients with colorectal cancer. Surgery represents the mainstream for curative treatment of colorectal cancer liver metastases (CRCLM) with long-term survival up to 58 and 36 % at 5 and 10 years, respectively. Despite advances on diagnosis, staging and surgical strategies, 60-70 % of patients will develop recurrence of the disease even after R0 resection of CRCLM. Tumor staging, prognosis, and therapeutic approaches for cancer are most often based on the extent of involvement of regional lymph nodes (LNs) and, to a lesser extent, on the invasion of regional lymphatic vessels draining the primary tumor. For CRCLM, the presence of intra hepatic lymphatic and blood vascular dissemination has been associated with an increased risk of intra hepatic recurrence, poorer disease-free and overall survival after liver resection. Also, several studies have reviewed the role of surgery in the patient with concomitant CRCLM and liver pedicle LN metastasis. Although pedicle LN involvement is related to worst survival rates, it does not differentiate patients that will relapse from those that will not. This review aims to briefly describe the anatomy of the liver's lymphatic drainage, the incidence of intrahepatic lymphatic invasion and hilar lymph node involvement, as well as their clinical impact in CRCLM. A better understanding of the role of liver lymphatic metastasis might, in the near future, impact the strategy of systemic therapies after liver resection as for primary colorectal tumors.
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Beppu T, Sakamoto Y, Imai K, Hayashi H, Nitta H, Miyamoto Y, Chikamoto A, Watanabe M, Baba H. A patient with colorectal liver metastases with para-aortic regional lymph node metastases who survived for 7 years. Int Cancer Conf J 2014. [DOI: 10.1007/s13691-013-0136-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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22
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Castellanos JA, Merchant NB. Strategies for Management of Synchronous Colorectal Metastases. CURRENT SURGERY REPORTS 2014; 2:62. [PMID: 25431745 DOI: 10.1007/s40137-014-0062-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The management of synchronous presentation of colorectal cancer and liver metastases has long been a topic of debate and discussion for surgeons due to the unique dilemma of balancing operative timing along with treatment strategy. Operative strategies for resection include staged resection with colon first approach, "reverse" staged resection with liver metastases resected first, and one-stage, or simultaneous, resection of both the primary tumor and liver metastases approach. These operative strategies can be further augmented with perioperative chemotherapy and other novel approaches that may improve resectability and patient survival. The decision on operative timing and approach, however, remains largely dependent on the surgeon's determination of disease resectability, patient fitness, and the need for neoadjuvant chemotherapy.
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Affiliation(s)
- Jason A Castellanos
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nipun B Merchant
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Liu W, Yan XL, Wang K, Bao Q, Sun Y, Xing BC. The outcome of liver resection and lymphadenectomy for hilar lymph node involvement in colorectal cancer liver metastases. Int J Colorectal Dis 2014; 29:737-45. [PMID: 24743847 DOI: 10.1007/s00384-014-1863-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Hepatic hilar lymph node (HLN) involvement is considered as a poor prognostic factor during liver resection in colorectal liver metastases (CLM). The purpose of this study is to identify the clinical factors that distinguish HLN-positive patients from those who are hilar lymph node negative and to evaluate the frequency of macroscopic involvement of hepatic HLN, to investigate the impact of HLN involvement on survival after resection for CLM with lymphadenectomy and adjuvant chemotherapy. PATIENTS AND METHODS Between January 2000 and August 2012, 73 selected CLM patients underwent liver resections with lymphadenectomy in the Hepatopancreatobiliary Surgery Department I of Beijing Cancer Hospital. Clinical data, surgical outcome, and prognosis after operation of patients with HLN involvement were compared with that of patients without HLN involvement. RESULTS Of the 73 patients who underwent liver resections with lymphadenectomy, 12 (16.4 %) patients had HLN involvement identified by pathology. Compared with patients without HLN involvement, the frequency of lymph nodes metastasis for primary tumor was significantly higher in HLN-positive patients (p = 0.023). For CLM patients with and without HLN involvement, 5-year overall survival (OS) was 16.2 and 37.1 %, respectively (p = 0.04). Five-year disease-free survival (DFS) rates were 0 and 32.9 % (p = 0.034). Multivariate analysis showed that involved resected HLN was an independent risk factor for overall survival. CONCLUSION We should suspect HLN involvement in patients with colorectal cancer liver metastases when they have regional lymph nodes of primary tumor metastasis. Liver resection with HLN dissection might offer a unique curative opportunity for CLM patients with HLN involvement.
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Affiliation(s)
- Wei Liu
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, No. 52, Fu-Cheng-Lu Street, Beijing, 100142, People's Republic of China
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24
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The Evolving Use of Prognostic Factors After Resection of Colorectal Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2014. [DOI: 10.1007/s11888-014-0220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abbadi RA, Sadat U, Jah A, Praseedom RK, Jamieson NV, Cheow HK, Whitley S, Ford HE, Wilson CB, Harper SJF, Huguet EL. Improved long-term survival after resection of colorectal liver metastases following staging with FDG positron emission tomography. J Surg Oncol 2014; 110:313-9. [PMID: 24737685 DOI: 10.1002/jso.23623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/25/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Actual long-term survival of patients with colorectal liver metastases staged by PET CT has not been reported. Objectives were to investigate whether PET CT staging results in actual improved long-term survival, to examine outcome in patients with 'equivocal' PET CT scans, and those excluded from hepatectomy by PET CT. METHODS A retrospective analysis of patients undergoing hepatectomy for colorectal liver metastases between March 1998 and September 2008. RESULTS Overall 5- and 10-year survival was 44.8% and 23.9%. PET CT staging resulted in management changes in 23% of patients. PET CT staged patients showed significantly better survival than those staged by CT alone at 3 years (79.8% vs. 54.1%) and at 5 years (54.1% vs. 37.3%) with median survivals of 6.4 years versus 3.9 years (log rank P = 0.018). Patients with equivocal PET CT scans showed worse median survival than those with favourable PET CT (log rank P = 0.002), but may include a subpopulation whose prognosis trends towards a more favourable outcome than those excluded from liver resection by PET CT, whose median survival remains limited to 21 months. CONCLUSIONS Staging of patients with colorectal liver metastases by PET CT is associated with significantly improved actual long-term survival, and provides valuable prognostic information which guides surgical and oncological treatments.
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Affiliation(s)
- Reyad A Abbadi
- Department of Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Christophi C, Nguyen L, Muralidharan V, Nikfarjam M, Banting J. Lymphatics and colorectal liver metastases: the case for sentinel node mapping. HPB (Oxford) 2014; 16:124-30. [PMID: 23869986 PMCID: PMC3921007 DOI: 10.1111/hpb.12118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 03/21/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic resection remains the treatment of choice for patients with colorectal liver metastases (CLM). Indications for hepatic resection have been extended to include extrahepatic lymph node groups, resulting in increased survival benefits. The identification of specific lymph pathways and involved nodes is necessary to support the development of guidelines for a more focused approach to the management of this disease. The feasibility of sentinel node mapping should be investigated to define specific lymphatic groups involved in CLM. METHODS Scientific papers published from 1950 to 2012 were sought and extracted from the MEDLINE, PubMed and University of Melbourne databases. RESULTS Several studies have reported microscopic lymph node involvement in 10-15% of patients undergoing hepatic resection for CLM in which no macroscopic involvement was evident. In retrospect, over 80% of lymphadenectomies are proven unnecessary. Traditional imaging modalities have limited predictive value in detecting lymph node involvement. Sentinel node mapping has proved an extremely accurate tool in detecting lymph node involvement and can identify patients in whom lymphadenectomy may be beneficial. CONCLUSIONS Current imaging techniques are inadequate to detect microscopic lymph node involvement in patients with resectable CLM. The use of sentinel node mapping is proposed to identify nodal groups involved and provide management strategies.
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Affiliation(s)
- Christopher Christophi
- Christopher Christophi, Department of Surgery, University of Melbourne, Austin Hospital, Lance Townsend Building Level 8, Studley Road, Heidelberg, Vic 3084, Australia. Tel: + 61 3 9496 5492. Fax: + 61 3 9458 1650. E-mail:
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McNally SJ, Parks RW. Surgery for colorectal liver metastases. Dig Surg 2013; 30:337-47. [PMID: 24051581 DOI: 10.1159/000351442] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 04/10/2013] [Indexed: 12/27/2022]
Abstract
Half of all patients with colorectal cancer develop metastatic disease. The liver is the principal site for metastases, and surgical resection is the only modality that offers the potential for long-term cure. Appropriate patient selection for surgery and improvements in perioperative care have resulted in low morbidity and mortality rates, resulting in this being the therapy of choice for suitable patients. Modern management of colorectal liver metastases is multimodal incorporating open and laparoscopic surgery, ablative therapies such as radiofrequency ablation or microwave ablation and (neo)adjuvant chemotherapy. The majority of patients with hepatic metastases should be considered for resectional surgery, if all disease can be resected, as this offers the only opportunity for prolonged survival.
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Affiliation(s)
- S J McNally
- Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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Sourrouille I, Mordant P, Maggiori L, Dokmak S, Lesèche G, Panis Y, Belghiti J, Castier Y. Long-term survival after hepatic and pulmonary resection of colorectal cancer metastases. J Surg Oncol 2013; 108:220-4. [PMID: 23893480 DOI: 10.1002/jso.23385] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/01/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recent changes in adjuvant therapies improved the prognosis of metastatic colorectal cancers. Curative resection may be considered, even for both pulmonary and hepatic metastases, but prognostic factors are not well identified. METHODS From 1995 to 2010, 69 patients had curative resection of pulmonary metastases of colorectal cancer; 31 had also hepatic metastases. Pulmonary and hepatic resection occurred in 2 steps (87%). We studied overall and disease-free survival and prognostic factors. RESULTS Primary tumor location was the rectum in 10 cases (32%). Pulmonary metastases were synchronous in 5 (16%) and bilateral in 6 (19%). One patient (3%) died after pulmonary surgery. One (3%) had positive surgical margins for pulmonary metastases. Median overall survival was 44 months (5-year rate = 36%); median disease-free survival was 22 months (5-year rate = 10%). Factors linked to impaired survival were rectal primary tumor (P = 0.04) and bilateral pulmonary metastases (P = 0.02) for overall survival, and pulmonary metastase ≥ 20 mm (P = 0.04) for disease-free survival. CONCLUSION When associated to adjuvant therapy, complete resection of pulmonary and hepatic metastases of colorectal cancer allows long-term survival in one third of the patients.
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Affiliation(s)
- Isabelle Sourrouille
- Department of Thoracic, Groupe Hospitalier Bichat-Beaujon, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Paris, Clichy, France
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Gallinger S, Biagi JJ, Fletcher GG, Nhan C, Ruo L, McLeod RS. Liver resection for colorectal cancer metastases. ACTA ACUST UNITED AC 2013; 20:e255-65. [PMID: 23737695 DOI: 10.3747/co.20.1341] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
QUESTIONS Should surgery be considered for colorectal cancer (crc) patients who have liver metastases plus (a) pulmonary metastases, (b) portal nodal disease, or (c) other extrahepatic metastases (ehms)?What is the role of chemotherapy in the surgical management of crc with liver metastases in (a) patients with resectable disease in the liver, or (b) patients with initially unresectable disease in the liver that is downsized with chemotherapy ("conversion")?What is the role of liver resection when one or more crc liver metastases have radiographic complete response (rcr) after chemotherapy? PERSPECTIVES Advances in chemotherapy have improved survival in crc patients with liver metastases. The 5-year survival with chemotherapy alone is typically less than 1%, although two recent studies with folfox or folfoxiri (or both) reported rates of 5%-10%. However, liver resection is the treatment that is most effective in achieving long-term survival and offering the possibility of a cure in stage iv crc patients with liver metastases. This guideline deals with the role of chemotherapy with surgery, and the role of surgery when there are liver metastases plus ehms. Because only a proportion of patients with crc metastatic disease are considered for liver resection, and because management of this patient population is complex, multidisciplinary management is required. METHODOLOGY Recommendations in the present guideline were formulated based on a prepublication version of a recent systematic review on this topic. The draft methodology experts, and external review by clinical practitioners. Feedback was incorporated into the final version of the guideline. PRACTICE GUIDELINE These recommendations apply to patients with liver metastases from crc who have had or will have a complete (R0) resection of the primary cancer and who are being considered for resection of the liver, or liver plus specific and limited ehms, with curative intent. 1(a). Patients with liver and lung metastases should be seen in consultation with a thoracic surgeon. Combined or staged metastasectomy is recommended when, taking into account anatomic and physiologic considerations, the assessment is that all pulmonary metastases can also be completely removed. Furthermore, liver resection may be indicated in patients who have had a prior lung resection, and vice versa.1(b). Routine liver resection is not recommended in patients with portal nodal disease. This group includes patients with radiologically suspicious portal nodes or malignant portal nodes found preoperatively or intraoperatively. Liver plus nodal resection, together with perioperative systemic therapy, may be an option-after a full discussion with the patient-in cases with limited nodal involvement and with metastases that can be completely resected.1(c). Routine liver resection is not recommended in patients with nonpulmonary ehms. Liver plus extrahepatic resection, together with perioperative systemic therapy, may be an option-after a full discussion with the patient-for metastases that can be completely resected.2(a). Perioperative chemotherapy, either before and after resection, or after resection, is recommended in patients with resectable liver metastatic disease. This recommendation extends to patients with ehms that can be completely resected (R0). Risks and potential benefits of perioperative chemotherapy should be discussed for patients with resectable liver metastases. The data on whether patients with previous oxaliplatin-based chemotherapy or a short interval from completion of adjuvant therapy for primary crc might benefit from perioperative chemotherapy are limited.2(b). Liver resection is recommended in patients with initially unresectable metastatic liver disease who have a sufficient downstaging response to conversion chemotherapy. If complete resection has been achieved, postoperative chemotherapy should be considered.3. Surgical resection of all lesions, including lesions with rcr, is recommended when technically feasible and when adequate functional liver can be left as a remnant. When a lesion with rcr is present in a portion of the liver that cannot be resected, surgery may still be a reasonable therapeutic strategy if all other visible disease can be resected. Postoperative chemotherapy might be considered in those patients. Close follow-up of the lesion with rcr is warranted to allow localized treatment or further resection for an in situ recurrence.
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Affiliation(s)
- S Gallinger
- Hepatobiliary/Pancreatic Surgical Oncology, University Health Network, Mount Sinai Hospital, and University of Toronto, Toronto, ON
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Ribero D, Viganò L, Amisano M, Capussotti L. Prognostic factors after resection of colorectal liver metastases: from morphology to biology. Future Oncol 2013; 9:45-57. [PMID: 23252563 DOI: 10.2217/fon.12.159] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Despite improved overall survival rates after potentially curative liver resection (~50-58% at 5 years), almost half of patients experience disease recurrence highlighting the need for a precise definition of outcomes to stratify patients for clinical trials and to guide treatment decisions. In the past, several factors, such as an advanced primary T stage, the primary N+ status, a large tumor size, multiple tumors, a disease-free interval of <12 months, an elevated carcinoembryonic antigen level, the presence of an extrahepatic disease, and the margin width (<1 cm) and status (positive), have been recognized to predict poor outcomes, but most of them lack the sensitivity for accurate individual prognostication. Thus, in recent years, new factors, such as response to chemotherapy, either clinical or pathological, that more closely reflect tumor biology have been established and adopted in the clinical practice. Similarly, biomarkers of poor prognosis, especially mutations in KRAS and BRAF and the expression of thymidylate synthase, have been studied, yielding promising results. However, robust evidence of their prognostic utility awaits prospective validation.
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Affiliation(s)
- Dario Ribero
- Department of General Surgery & Surgical Oncology, Ospedale Mauriziano Umberto I, Torino, Italy
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Management of the Hepatic Lymph Nodes During Resection of Liver Metastases from Colorectal Cancer: A Systematic Review. CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-013-0165-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lupinacci RM, Coelho FF, Perini MV, Lobo EJ, Ferreira FG, Szutan LA, Lopes GDJ, Herman P. Manejo atual das metástases hepáticas de câncer colorretal: recomendações do Clube do Fígado de São Paulo. Rev Col Bras Cir 2013; 40:251-60. [DOI: 10.1590/s0100-69912013000300016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 10/01/2012] [Indexed: 02/08/2023] Open
Abstract
Aproximadamente metade dos pacientes portadores de câncer colorretal apresenta metástases hepáticas durante a evolução de sua doença que afetam diretamente o prognóstico e são diretamente responsáveis por 2/3 dos óbitos relacionados à doença. Nas últimas duas décadas o tratamento das metástases hepáticas de câncer colorretal (MHCCR) proporcionou ganho expressivo na sobrevida quando todas as opções terapêuticas são colocadas à disposição do paciente. Nesse contexto, o tratamento cirúrgico persiste como a única possibilidade de cura com índices de sobrevida em cinco anos de 25 a 58%. No entanto, apenas 1/4 dos pacientes tem doença ressecável ao diagnóstico. Por essa razão, um dos pontos fundamentais no manejo atual dos pacientes com MHCCR é o desenvolvimento de estratégias que possibilitem a ressecção completa das lesões hepáticas. O advento e aperfeiçoamento dos métodos ablativos expandiram as possibilidades da terapêutica cirúrgica, além disto, o surgimento de novos esquemas quimioterápicos e a introdução das terapias-alvo proporcionou altas taxas de resposta e alteraram definitivamente o manejo destes pacientes. O tratamento multimodal e a utilização da experiência de diversas especialidades médicas permitiram que o tratamento das MHCCR se aproximasse cada vez mais do tratamento ideal, ou seja, individualizado. Baseado em uma extensa revisão da literatura e na experiência de alguns dos centros especializados mais importantes do Brasil, o Clube do Fígado de São Paulo iniciou um trabalho de discussão multi-institucional que resultou nas recomendações que se seguem. Essas recomendações, no entanto, não visam ser absolutas, mas sim ferramentas úteis no processo de decisão terapêutica desse grupo complexo de pacientes.
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Affiliation(s)
| | | | | | | | | | - Luiz Arnaldo Szutan
- Universidade de São Paulo; Universidade Federal de São Paulo; Santa Casa de São Paulo
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33
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Alvarez FA, Ardiles V, de Santibañes E. The ALPPS Approach for the Management of Colorectal Carcinoma Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-013-0159-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Adams RB, Aloia TA, Loyer E, Pawlik TM, Taouli B, Vauthey JN. Selection for hepatic resection of colorectal liver metastases: expert consensus statement. HPB (Oxford) 2013; 15:91-103. [PMID: 23297719 PMCID: PMC3719914 DOI: 10.1111/j.1477-2574.2012.00557.x] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 07/29/2012] [Indexed: 02/06/2023]
Abstract
Hepatic resection offers a chance of a cure in selected patients with colorectal liver metastases (CLM). To achieve adequate patient selection and curative surgery, (i) precise assessment of the extent of disease, (ii) sensitive criteria for chemotherapy effect, (iii) adequate decision making in surgical indication and (iv) an optimal surgical approach for pre-treated tumours are required. For assessment of the extent of the disease, contrast-enhanced computed tomography (CT) and/or magnetic resonance imaging (MRI) with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is recommended depending on the local expertise and availability. Positron emission tomography (PET) and PET/CT may offer additive information in detecting extrahepatic disease. The RECIST criteria are a reasonable method to evaluate the effect of chemotherapy. However, they are imperfect in predicting a pathological response in the era of modern systemic therapy with biological agents. The assessment of radiographical morphological changes is a better surrogate of the pathological response and survival especially in the patients treated with bevacizumab. Resectability of CLM is dependent on both anatomic and oncological factors. To decrease the surgical risk, a sufficient volume of liver remnant with adequate blood perfusion and biliary drainage is required according to the degree of histopathological injury of the underlying liver. Portal vein embolization is sometimes required to decrease the surgical risk in a patient with small future liver remnant volume. As a complete radiological response does not signify a complete pathological response, liver resection should include all the site of a tumour detected prior to systemic treatment.
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Affiliation(s)
- Reid B Adams
- Division of General Surgery, University of Virginia School of MedicineCharlottesville, VA, USA
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Evelyne Loyer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Timothy M Pawlik
- Department of Surgery, Johns Hopkins UniversityBaltimore, MD, USA
| | - Bachir Taouli
- Department of Radiology, Mount Sinai Medical CenterNew York, NY, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
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35
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Blackham AU, Swett K, Levine EA, Shen P. Surgical management of colorectal cancer metastases to the liver: multimodality approach and a single institutional experience. COLORECTAL CANCER 2013; 2:73-88. [PMID: 25110522 DOI: 10.2217/crc.12.80] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Over the past 30 years, the treatment of metastatic colorectal cancer to the liver has undergone major changes. Once considered terminal and incurable, the prognosis of patients with colorectal hepatic metastases has seen dramatic improvements using modern multimodality therapy and now long-term survival and even cure are possible in some patients. Despite the advances seen in systemic therapy, hepatic resection offers the longest survival potential and remains the only curative option. Based on long-term outcomes and the improved safety of hepatic resection using modern operative techniques and critical care support, an aggressive locoregional approach to colorectal hepatic metastasis has become the standard of care. This article focuses on the management of colorectal hepatic metastases and highlights the importance of multimodality therapy. We also report our 18-year experience treating patients with hepatic resection for colorectal metastases.
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Affiliation(s)
- Aaron U Blackham
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katrina Swett
- Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Perry Shen
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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36
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Ramia JM, Figueras J, de la Plaza R, García-Parreño J. [Resection of liver metastases in patients with extrahepatic disease]. Cir Esp 2012; 90:483-9. [PMID: 22682358 DOI: 10.1016/j.ciresp.2012.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 11/22/2011] [Accepted: 01/05/2012] [Indexed: 02/07/2023]
Abstract
Patients who have liver metastasis and extrahepatic metastatic disease (EMD) have been considered as a patient subgroup with a very poor prognosis. Therefore, the presence of EMD was traditionally considered a contraindication for liver resection. But, survivals of around 30% at 5 years, and higher than that achieved with chemotherapy only obtained in some patients with liver metastasis of colorectal origin and EMD who had a resection performed on the hepatic and extrahepatic disease, obliges us to re-think what we must do in these patients. We have carried out an exhaustive review of the literature in an attempt to establish some working guidelines based on current scientific evidence. In summary, we can say that the presence of resectable EMD in patients with liver metastasis must not be considered as an absolute contraindication for liver resection, although the results are inferior to those obtained in patients without EMD. Patients with EMD localised in the ganglia of the coeliac trunk or aorto-cava have a short survival. The use of chemotherapy prior to the surgery is recommended to operate stable patients, or who respond to the chemotherapy and not in progression.
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Affiliation(s)
- José M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
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37
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Johnston FM, Kneuertz PJ, Pawlik TM. Resection of non-hepatic colorectal cancer metastasis. J Gastrointest Oncol 2012; 3:59-68. [PMID: 22811870 DOI: 10.3978/j.issn.2078-6891.2012.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 01/13/2012] [Indexed: 12/15/2022] Open
Affiliation(s)
- Fabian M Johnston
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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38
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The role of liver resection for colorectal cancer metastases in an era of multimodality treatment: A systematic review. Surgery 2012; 151:860-70. [DOI: 10.1016/j.surg.2011.12.018] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 12/22/2011] [Indexed: 12/14/2022]
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39
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Routine pedicular lymphadenectomy for colorectal liver metastases. J Am Coll Surg 2012; 214:e39-45. [PMID: 22521440 DOI: 10.1016/j.jamcollsurg.2012.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 02/15/2012] [Indexed: 12/22/2022]
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40
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Maroulis I, Karavias DD, Karavias D. General principles of hepatectomy in colorectal liver metastases. Tech Coloproctol 2012; 15 Suppl 1:S13-6. [PMID: 21887560 DOI: 10.1007/s10151-011-0750-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hepatic resection for colorectal liver metastases remains the only therapeutic option that improves long-term survival and offers potential cure. By conventional resectability criteria, only a limited number of patients with metastatic disease can be subjected to surgical intervention. In the past decade, better understanding of the natural history of the disease, the introduction of new chemotherapy agents and the advances in surgical techniques have led to more patients being eligible for surgery. Neoadjuvant chemotherapy can reduce the size of the metastases, allowing operation on patients who were previously considered inoperable. Major resections can nowadays be safely performed with the development of new less-invasive techniques and with the use of supplementary tools like ablation techniques. Using portal vein embolization to induce hypertrophy of future liver remnant and combining it with two-staged hepatectomy allow more patients with advanced disease to undergo potentially curative surgery. Careful selection of patients and aggressive surgery in experienced centers improve survival rates.
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Affiliation(s)
- I Maroulis
- Department of Surgery, University Hospital of Patras, 26504 Rion, Greece
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41
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Viana EF, Herman P, Coelho FF, Taka TA, D'Albuquerque LAC, Cecconello I. The role of hilar lymphadenectomy in patients subjected to hepatectomy due to colorectal metastasis. ARQUIVOS DE GASTROENTEROLOGIA 2012; 48:217-9. [PMID: 21952709 DOI: 10.1590/s0004-28032011000300012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 08/13/2010] [Indexed: 11/22/2022]
Abstract
CONTEXT Hepatectomy is the treatment of choice for colorectal liver metastases, and several studies have shown good results, with 5-year survival rates ranging from 40% to 57%. Several clinical and pathological predictive factors for survival after liver resection have been studied. Involvement of the hepatic hilum lymph nodes, the incidence of which varies from 2% to 10%, indicates a poor long-term prognosis. RESULTS Despite variable results, some authors have reported a not-insignificant improvement in survival rate in liver-metastasis patients with hilar lymph node involvement who undergo combined liver resection and lymphadenectomy. Due to the low rates of morbidity and mortality for liver-resection surgery, several specialized centers perform liver resections combined with lymphadenectomies in selected cases. It should be noted that the therapeutic value of systemic lymphadenectomy is not yet entirely understood, and only controlled studies comparing groups with and without lymphadenectomy can fully resolve the issue. CONCLUSION In any case, hilar lymph node dissection has been shown to be a useful tool for improving the accuracy of extra hepatic disease staging, regardless of its impact on survival.
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Abstract
Management of Neuroendocrine liver metastases (NELM) is challenging. The presence of NELM worsens survival outcome and almost 10% of all liver metastases are neuroendocrine in origin. There is no firm consensus on the optimal treatment strategy for NELM. A systematic search of the PubMed database was performed from 1995-2010, to collate the current evidence and formulate a sound management algorithm. There are 22 case series with a total of 793 patients who had undergone surgery for NELM. The overall survival ranges from 46-86% at 5 years, 35-79% at 10 years, and the median survival ranges from 52-123 months. After successful cytoreductive surgery, the mean duration of symptom reduction is between 16-26 months, and the 5-year recurrence/progression rate ranges from 59-76%. Five studies evaluated the efficacy of a combination cytoreductive strategy reporting survival rate of ranging from 83% at 3 years to 50% at 10 years. To date, there is no level 1 evidence comparing surgery versus other liver-directed treatment options for NELM. An aggressive surgical approach, including combination with additional liver-directed procedures is recommended as it leads to long-term survival, significant long-term palliation, and a good quality of life. A multidisciplinary approach should be established as the platform for decision making.
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Grundmann RT. Current state of surgical treatment of liver metastases from colorectal cancer. World J Gastrointest Surg 2011; 3:183-96. [PMID: 22224173 PMCID: PMC3251742 DOI: 10.4240/wjgs.v3.i12.183] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 10/23/2011] [Accepted: 11/01/2011] [Indexed: 02/06/2023] Open
Abstract
Hepatic resection is the procedure of choice for curative treatment of colorectal liver metastases (CLM). Objectives of surgical strategy are low intraoperative blood loss, short liver ischemic times and minor postoperative morbidity and mortality. Blood loss is an independent predictor of mortality and compromises, in common with postoperative complications, long-term outcome after hepatectomy for CLM. The type of liver resection has no impact on the outcome of patients with CLM; wedge resections are not inferior to anatomical resections in terms of tumor clearance, pattern of recurrence or survival. Despite the lack of proof of survival benefit, routine lymphadenectomy has been advocated, allowing the detection of microscopic lymph node metastases and with prognostic value. In experienced hands, minimally invasive liver surgery is safe with acceptable morbidity and mortality and oncological results comparable to open hepatic surgery, but with reduced blood loss and earlier recovery. The European Colorectal Metastases Treatment Group recommended treating up front with chemotherapy for patients with both resectable and unresectable CLM. However, neoadjuvant chemotherapy can induce damage to the remnant liver, dependent on the number of chemotherapy cycles. Therefore, in our opinion, preoperative chemotherapy should be reserved for patients whose CLM are marginally resectable or unresectable. A meta analysis of randomized trials dealing with perioperative chemotherapy for the treatment of resectable CLM demonstrated a benefit of systemic chemotherapy but did not answer the question of whether a neoadjuvant or adjuvant approach should be preferred. Analysis of the literature demonstrates that the results of specialized centers cannot be attained in the reality of comprehensive patient care. Reasons behind the commonly poorer results seen in cancer networks as compared with literature-based data are, on the one hand, geographical disparities in access to specialized surgical and medical care. On the other hand, a selection bias in the reports of the literature may be assumed. Studies of surgical resection for CLM derive almost exclusively from case series generally drawn from large academic centers where patient selection or surgical expertise is superior to what is found in many communities. Therefore, we may conclude that the comprehensive propagation of the standards outlined in this paper constitutes a major task in the near future to reduce the variations in survival of patients with CLM.
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Affiliation(s)
- Reinhart T Grundmann
- Reinhart T Grundmann, Kreiskliniken Altötting-Burghausen, In den Grüben 144, D-84489 Burghausen, Germany
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44
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Masi G, Fornaro L, Caparello C, Falcone A. Liver metastases from colorectal cancer: how to best complement medical treatment with surgical approaches. Future Oncol 2011; 7:1299-323. [DOI: 10.2217/fon.11.108] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Colorectal liver metastases (CLM) represent a major challenge for oncologists and surgeons. In fact, in this setting, the optimal treatment of patients can achieve a long-term survival and sometimes a definitive cure of disease. In recent years, improvements in both medical therapies and surgical approaches have led to an increased rate of patients considered amenable for surgery on CLM. New perspectives in the management of CLM underline the need for a comprehensive assessment of patient and tumor characteristics, to integrate technical and prognostic issues into an individualized therapeutic strategy in different patient subgroups. The multidisciplinary evaluation from the onset and during treatment remains the key element to maximizing the benefit of more intensive treatment modalities.
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Affiliation(s)
| | - Lorenzo Fornaro
- U.O. Oncologia Medica Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Chiara Caparello
- U.O. Oncologia Medica Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Alfredo Falcone
- U.O. Oncologia Medica Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
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45
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Significance of Hepatic Lymph Node Metastasis in Patients With Unresectable Synchronous Liver Metastasis of Colorectal Cancer. Int Surg 2011; 96:291-9. [DOI: 10.9738/cc22.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
The frequency and significance of hepatic lymph node (HLN) metastasis were retrospectively evaluated in 43 patients with unresectable synchronous liver metastasis of colorectal cancer who underwent resection of the primary tumor and histopathologic evaluation of HLNs between March 1997 and August 2007. HLN metastasis was detected in 12 patients (27.9%). No significant correlations were observed between the presence of HLN metastasis and any of the 12 clinicopathologic factors examined. On multivariate analysis using the Cox proportional hazards model, the presence of HLN metastasis (P = 0.002), along with a large number (≥4) of regional lymph node metastases (P = 0.003), and nonuse of oxaliplatin-based chemotherapy (P = 0.005) were identified as independent risk factors for shorter survival. To establish a new therapeutic strategy for initially unresectable liver metastasis of colorectal cancer, HLNs should be examined histologically in patients undergoing resection of hepatic lesions when they are rendered resectable by effective chemotherapy.
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Misiakos EP, Karidis NP, Kouraklis G. Current treatment for colorectal liver metastases. World J Gastroenterol 2011; 17:4067-75. [PMID: 22039320 PMCID: PMC3203357 DOI: 10.3748/wjg.v17.i36.4067] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 11/30/2010] [Accepted: 12/07/2010] [Indexed: 02/06/2023] Open
Abstract
Surgical resection offers the best opportunity for survival in patients with colorectal cancer metastatic to the liver, with five-year survival rates up to 58% in selected cases. However, only a minority are resectable at the time of diagnosis. Continuous research in this field aims at increasing the percentage of patients eligible for resection, refining the indications and contraindications for surgery, and improving overall survival. The use of surgical innovations, such as staged resection, portal vein embolization, and repeat resection has allowed higher resection rates in patients with bilobar disease. The use of neoadjuvant chemotherapy allows up to 38% of patients previously considered unresectable to be significantly downstaged and eligible for hepatic resection. Ablative techniques have gained wide acceptance as an adjunct to surgical resection and in the management of patients who are not surgical candidates. Current management of colorectal liver metastases requires a multidisciplinary approach, which should be individualized in each case.
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47
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Rau C, Blanc B, Ronot M, Dokmak S, Aussilhou B, Faivre S, Vilgrain V, Paradis V, Belghiti J. Neither preoperative computed tomography nor intra-operative examination can predict metastatic lymph node in the hepatic pedicle in patients with colorectal liver metastasis. Ann Surg Oncol 2011; 19:163-8. [PMID: 21837526 DOI: 10.1245/s10434-011-1994-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND In patients operated on for colorectal liver metastasis (CRLM), metastatic lymph node (LN) of the hepatic pedicle is a major prognostic factor. Efficiency of preoperative computed tomography (CT) and intraoperative examination for the diagnosis of metastatic LN of hepatic pedicle is prospectively evaluated. METHODS From January 2008 to June 2010, 76 patients underwent liver resection for CRLM, with systematic LN pedicle dissection. Preoperative CT scan evaluated prospectively location, size, and aspect of LN, whereas the surgeon assessed size and consistency of LN Results of CT and intraoperative findings were compared with pathologic findings to determine sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). RESULTS A total of 241 nodes were analyzed (3.2 ± 2.1 LN per patient). Systematic LN dissection increased the operative time by a mean of 20 ± 12.5 min, without any specific morbidity or mortality related to the LN clearance. Metastatic LN in the hepatic pedicle was observed in 15 (20%) patients and were unrelated to the number, size, and location of CRLM. NPV and PPV of the preoperative CT scan was 85 and 56%, respectively. Intraoperative evaluation of LN had a high NPV of 91% with a low PPV of 43%. Even with the combination of CT and intraoperative evaluation, 27% of the patients with a pathological metastatic LN were not suspected. CONCLUSIONS Because neither the preoperative CT nor the surgical evaluation accurately predicts metastatic LN in the hepatic pedicle, accurate oncological staging require a systematic pedicular LN clearance during liver resection for CRLM.
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Affiliation(s)
- Cédric Rau
- Department of HPB Surgery, Beaujon Hospital, Clichy, France
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48
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Pulitanò C, Bodingbauer M, Aldrighetti L, Choti MA, Castillo F, Schulick RD, Gruenberger T, Pawlik TM. Colorectal liver metastasis in the setting of lymph node metastasis: defining the benefit of surgical resection. Ann Surg Oncol 2011; 19:435-42. [PMID: 21743977 DOI: 10.1245/s10434-011-1902-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Indexed: 01/12/2023]
Abstract
BACKGROUND For patients with colorectal liver metastasis (CLM), the presence of concomitant perihepatic/para-aortic lymph node metastasis (LNM) is considered a contraindication to liver resection. We sought to determine the benefits of liver resection among patients with CLM + LNM by examining long-term outcomes among a large cohort of patients. METHODS Between October 1996 and December 2007, 61 patients with CLM and pathologically proven LNM were identified from an international multi-institutional database of 1629 patients. The effect of LNM, as well as other prognostic factors, on recurrence-free and overall survival was analyzed. RESULTS Median overall survival was 32 months, and 1-, 3-, and 5-year overall survival were 86, 35, and 18%, respectively. Five patients were alive and disease-free at last follow-up. Survival was associated with location of LNM. Specifically, 5-year overall survival was 30% among patients with LNM along the hepatoduodenal ligament/retropancreatic area (area 1), 14% among patients with LNM along the common hepatic artery/celiac axis (area 2), and there was only one long-term survivor who experienced recurrent disease among patients who had CLM + para-aortic LNM (area 3) (P = 0.004). On multivariate analyses, overall margin status (hazard ratio [HR] = 2.0), treated number of metastases >6 (HR = 2.3) and para-aortic lymph node involvement (HR = 2.6) each remained significantly associated with increased risk of death (all P < 0.05). CONCLUSIONS Although overall survival in the setting of LNM is only 18%, certain subsets of patients with LNM can benefit from surgical resection. Specifically, patients with CLM + LNM isolated to area 1 had a 5-year survival of approximately 30%, while long-term survival among patients with para-aortic LNM was rare.
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Affiliation(s)
- Carlo Pulitanò
- Department of Surgery, Hepatobiliary Surgery Unit, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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49
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Abbas S, Lam V, Hollands M. Ten-year survival after liver resection for colorectal metastases: systematic review and meta-analysis. ISRN ONCOLOGY 2011; 2011:763245. [PMID: 22091431 PMCID: PMC3200144 DOI: 10.5402/2011/763245] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 03/30/2011] [Indexed: 01/16/2023]
Abstract
Background. Liver resection in metastatic colorectal cancer is proved to result in five-year survival of 25–40%. Several factors have been investigated to look for prognostic factors stratifications such as resection margins, node involvement in the primary disease, and interval between the primary disease and liver metastases. Methods. We searched MEDLINE and EMBASE for studies that reported ten-year survival. Metaanalysis was performed to analyse the effect of recognised prognostic factors on cure rate for colorectal metastases. The meta-analysis was performed according to Ottawa-Newcastle method of analysis for nonrandomised trials and according to the guidelines of the PRISMA. Results. Eleven studies were included in the analysis, which showed a ten-year survival rate of 12–36%. Factors that have favourable impact are clear resection margin, low level of CEA, single metastatic deposit, and node negative disease. The only factor that excluded patients from cure is the positive status of the resection margin. Conclusion. Predicted ten-year survival after liver resection for colorectal metastases varies from 12 to 36%. Only positive resection margins resulted in no 10-year survivors. No patient can be excluded from consideration for liver resection so long the result is negative margins.
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Affiliation(s)
- Saleh Abbas
- Westmead Hospital, Wentworthville, NSW 2145, Australia
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Coimbra FJF, Pires TC, Junior WLDC, Diniz AL, Ribeiro HSDC. Avanços no tratamento cirúrgico das metástases hepáticas colorretais. Rev Assoc Med Bras (1992) 2011; 57:220-7. [DOI: 10.1590/s0104-42302011000200022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 01/25/2011] [Indexed: 12/28/2022] Open
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