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Cheng XF, Zhao F, Chen D, Liu FL. Current landscape of preoperative neoadjuvant therapies for initial resectable colorectal cancer liver metastasis. World J Gastroenterol 2024; 30:663-672. [PMID: 38515943 PMCID: PMC10950626 DOI: 10.3748/wjg.v30.i7.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/22/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Colorectal cancer liver metastasis (CRLM) presents a clinical challenge, and optimizing treatment strategies is crucial for improving patient outcomes. Surgical resection, a key element in achieving prolonged survival, is often linked to a heightened risk of recurrence. Acknowledging the potential benefits of preoperative neoadjuvant chemotherapy in managing resectable liver metastases, this approach has gained attention for its role in tumor downsizing, assessing biological behavior, and reducing the risk of postoperative recurrence. However, the use of neoadjuvant chemotherapy in initially resectable CRLM sparks ongoing debates. The balance between tumor reduction and the risk of hepatic injury, coupled with concerns about delaying surgery, necessitates a nuanced approach. This article explores recent research insights and draws upon the practical experiences at our center to address critical issues regarding considerations for initially resectable cases. Examining the criteria for patient selection and the judicious choice of neoadjuvant regimens are pivotal areas of discussion. Striking the right balance between maximizing treatment efficacy and minimizing adverse effects is imperative. The dynamic landscape of precision medicine is also reflected in the evolving role of gene testing, such as RAS/BRAF and PIK3CA, in tailoring neoadjuvant regimens. Furthermore, the review emphasizes the need for a multidisciplinary approach to navigate the complexities of CRLM. Integrating technical expertise and biological insights is crucial in refining neoadjuvant strategies. The management of progression following neoadjuvant chemotherapy requires a tailored approach, acknowledging the diverse biological behaviors that may emerge. In conclusion, this review aims to provide a comprehensive perspective on the considerations, challenges, and advancements in the use of neoadjuvant chemotherapy for initially resectable CRLM. By combining evidence-based insights with practical experiences, we aspire to contribute to the ongoing discourse on refining treatment paradigms for improved outcomes in patients with CRLM.
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Affiliation(s)
- Xiao-Fei Cheng
- Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Feng Zhao
- Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Dong Chen
- Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Fan-Long Liu
- Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Sugiyama M, Uehara H, Shin Y, Shiokawa K, Fujimoto Y, Mano Y, Komoda M, Nakashima Y, Sugimachi K, Yamamoto M, Morita M, Toh Y. Indications for conversion hepatectomy for initially unresectable colorectal cancer with liver metastasis. Surg Today 2022; 52:633-642. [PMID: 34762175 DOI: 10.1007/s00595-021-02403-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Selected patients with initially unresectable colorectal cancer (CRC) and liver metastases undergo conversion surgery after appropriate chemotherapy. The prognosis of these patients is good, with some even cured of the disease. This retrospective, single-institution study analyzes the clinical importance of patient characteristics on the outcomes of conversion hepatectomy. METHODS We evaluated 229 consecutive patients with initially unresectable CRC and liver metastasis, who underwent systemic chemotherapy. The patients were assigned to groups depending on conversion hepatectomy. RESULTS Conversion hepatectomy was performed in 30 patients (13.1%). The proportion of patients with extrahepatic metastasis was significantly lower in the conversion group than in the unresectable group (30.0 vs. 66.8%; P < 0.01). The rate of left-sided primary colorectal tumors was significantly higher in the conversion group than in the unresectable group (96.7 vs. 65.8%; P < 0.01). Multivariate analyses identified that left-sided tumors, no extrahepatic metastasis, H1 or H2 grade CLM, and treatment with molecular-targeted agents were associated with conversion hepatectomy (odds ratios: 16.314, 4.216, 7.631, and 4.070; P < 0.01). Overall survival was significantly longer in the conversion group than in the unresectable group (MST: 50.0 versus 14.7 months; P < 0.01). CONCLUSION Left-sided primary tumors, absence of extrahepatic metastases, H1 or H2 grade, and use of molecular-targeted agents were associated with successful conversion hepatectomy; thus, patients with these characteristics may be candidates for conversion therapy.
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Affiliation(s)
- Masahiko Sugiyama
- Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, Fukuoka, 811-1395, Japan.
| | - Hideo Uehara
- Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, Fukuoka, 811-1395, Japan
| | - Yuki Shin
- Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, Fukuoka, 811-1395, Japan
| | - Keiichi Shiokawa
- Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, Fukuoka, 811-1395, Japan
| | - Yoshiaki Fujimoto
- Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, Fukuoka, 811-1395, Japan
| | - Yohei Mano
- Hepato-Biliary-Pancreatic Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Masato Komoda
- Gastrointestinal and Medical Oncology, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Yuichiro Nakashima
- Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, Fukuoka, 811-1395, Japan
| | - Keishi Sugimachi
- Hepato-Biliary-Pancreatic Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Manabu Yamamoto
- Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, Fukuoka, 811-1395, Japan
| | - Masaru Morita
- Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, Fukuoka, 811-1395, Japan
| | - Yasushi Toh
- Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, Fukuoka, 811-1395, Japan
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Elfrink AKE, Kok NFM, van der Werf LR, Krul MF, Marra E, Wouters MWJM, Verhoef C, Kuhlmann KFD, den Dulk M, Swijnenburg RJ, Te Riele WW, van den Boezem PB, Leclercq WKG, Lips DJ, Nieuwenhuijs VB, Gobardhan PD, Hartgrink HH, Buis CI, Grünhagen DJ, Klaase JM. Population-based study on practice variation regarding preoperative systemic chemotherapy in patients with colorectal liver metastases and impact on short-term outcomes. Eur J Surg Oncol 2020; 46:1742-1755. [PMID: 32303416 DOI: 10.1016/j.ejso.2020.03.221] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/09/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Definitions regarding resectability and hence indications for preoperative chemotherapy vary. Use of preoperative chemotherapy may influence postoperative outcomes. This study aimed to assess the variation in use of preoperative chemotherapy for CRLM and related postoperative outcomes in the Netherlands. MATERIALS AND METHODS All patients who underwent liver resection for CRLM in the Netherlands between 2014 and 2018 were included from a national database. Case-mix factors contributing to the use of preoperative chemotherapy, hospital variation and postoperative outcomes were assessed using multivariable logistic regression. Postoperative outcomes were postoperative complicated course (PCC), 30-day morbidity and 30-day mortality. RESULTS In total, 4469 patients were included of whom 1314 patients received preoperative chemotherapy and 3155 patients did not. Patients receiving chemotherapy were significantly younger (mean age (+SD) 66.3 (10.4) versus 63.2 (10.2) p < 0.001) and had less comorbidity (Charlson scores 2+ (24% versus 29%, p = 0.010). Unadjusted hospital variation concerning administration of preoperative chemotherapy ranged between 2% and 55%. After adjusting for case-mix factors, three hospitals administered significantly more preoperative chemotherapy than expected and six administered significantly less preoperative chemotherapy than expected. PCC was 12.1%, 30-day morbidity was 8.8% and 30-day mortality was 1.5%. No association between preoperative chemotherapy and PCC (OR 1.24, 0.98-1.55, p = 0.065), 30-day morbidity (OR 1.05, 0.81-1.39, p = 0.703) or with 30-day mortality (OR 1.22, 0.75-2.09, p = 0.467) was found. CONCLUSION Significant hospital variation in the use of preoperative chemotherapy for CRLM was present in the Netherlands. No association between postoperative outcomes and use of preoperative chemotherapy was found.
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Affiliation(s)
- Arthur K E Elfrink
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Niels F M Kok
- Department of Surgery, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Leonie R van der Werf
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands
| | - Myrtle F Krul
- Department of Surgery, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Elske Marra
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands
| | - Koert F D Kuhlmann
- Department of Surgery, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Marcel den Dulk
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Wouter W Te Riele
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Wouter K G Leclercq
- Department of Surgery, Máxima Medical Centre, Eindhoven / Veldhoven, the Netherlands
| | - Daan J Lips
- Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands
| | | | | | - Henk H Hartgrink
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Carlijn I Buis
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands
| | - Joost M Klaase
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
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Ichikawa N, Kamiyama T, Yokoo H, Homma S, Maeda Y, Shinohara T, Tsuruga Y, Kazui K, Iijima H, Yoshida T, Taketomi A. Preoperative chemotherapy in colorectal cancer patients with synchronous liver metastasis. Mol Clin Oncol 2020; 12:374-383. [PMID: 32190322 DOI: 10.3892/mco.2020.1992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 11/13/2019] [Indexed: 02/05/2023] Open
Abstract
The response to preoperative chemotherapy is useful for predicting prognosis in unresectable and resectable disease. However, the prognostic benefit of chemotherapy prior to hepatectomy in patients with colorectal carcinoma and resectable or marginally resectable liver metastases remains unclear. The present study investigated the effect of preoperative chemotherapy on the prognosis of patients with colorectal cancer and resectable or marginally resectable synchronous liver metastasis. A total of 106 patients were retrospectively reviewed, who underwent hepatectomy for colorectal metastasis. The prognosis of 64 patients who received neoadjuvant chemotherapy (NAC) were compared with the 42 patients who did not (non-NAC). Furthermore, a total of 43 patients who responded to chemotherapy were compared with the 21 who did not. Preoperative chemotherapy was administered for 5.7 months, wherein 50 patients (78%) received a single regimen, and 54 (84%) received oxaliplatin. There were more patients with <3 metastases and maximum diameters <5 cm in the non-NAC group. The median survival time was 86.0 and 71.6 months in the NAC and non-NAC groups, respectively (P=0.33). Subgroup analysis on the basis of tumor size and number showed no prognostic differences between the two groups. The median survival time was longer in responders than in non-responders (85 vs. 56 months; P=0.01). However, the median relapse-free survival was equivalent in both groups (16.4 and 10.7 months). Preoperative chemotherapy did not prolong survival. Furthermore, it did not prevent recurrence, even in clinical responders. Therefore, it should not be routinely offered to patients with resectable liver metastasis before their hepatectomy.
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Affiliation(s)
- Nobuki Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Hideki Yokoo
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Shigenori Homma
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Yoshiaki Maeda
- Department of Gastroenterological Surgery, Hokkaido Cancer Center, Sapporo, Hokkaido 003-0804, Japan
| | - Toshiki Shinohara
- Department of Gastroenterological Surgery, Hokkaido Cancer Center, Sapporo, Hokkaido 003-0804, Japan
| | - Yosuke Tsuruga
- Department of Surgery, Hokkaido Hospital, Japan Community Healthcare Organization, Sapporo, Hokkaido 062-8618, Japan
| | - Keizo Kazui
- Department of Surgery, Hokkaido Hospital, Japan Community Healthcare Organization, Sapporo, Hokkaido 062-8618, Japan
| | - Hiroaki Iijima
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Hokkaido 060-8648, Japan
| | - Tadashi Yoshida
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
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Yoshino T, Arnold D, Taniguchi H, Pentheroudakis G, Yamazaki K, Xu RH, Kim TW, Ismail F, Tan IB, Yeh KH, Grothey A, Zhang S, Ahn JB, Mastura MY, Chong D, Chen LT, Kopetz S, Eguchi-Nakajima T, Ebi H, Ohtsu A, Cervantes A, Muro K, Tabernero J, Minami H, Ciardiello F, Douillard JY. Pan-Asian adapted ESMO consensus guidelines for the management of patients with metastatic colorectal cancer: a JSMO-ESMO initiative endorsed by CSCO, KACO, MOS, SSO and TOS. Ann Oncol 2019; 29:44-70. [PMID: 29155929 DOI: 10.1093/annonc/mdx738] [Citation(s) in RCA: 374] [Impact Index Per Article: 74.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The most recent version of the European Society for Medical Oncology (ESMO) consensus guidelines for the treatment of patients with metastatic colorectal cancer (mCRC) was published in 2016, identifying both a more strategic approach to the administration of the available systemic therapy choices, and a greater emphasis on the use of ablative techniques, including surgery. At the 2016 ESMO Asia Meeting, in December 2016, it was decided by both ESMO and the Japanese Society of Medical Oncology (JSMO) to convene a special guidelines meeting, endorsed by both ESMO and JSMO, immediately after the JSMO 2017 Annual Meeting. The aim was to adapt the ESMO consensus guidelines to take into account the ethnic differences relating to the toxicity as well as other aspects of certain systemic treatments in patients of Asian ethnicity. These guidelines represent the consensus opinions reached by experts in the treatment of patients with mCRC identified by the Presidents of the oncological societies of Japan (JSMO), China (Chinese Society of Clinical Oncology), Korea (Korean Association for Clinical Oncology), Malaysia (Malaysian Oncological Society), Singapore (Singapore Society of Oncology) and Taiwan (Taiwan Oncology Society). The voting was based on scientific evidence and was independent of both the current treatment practices and the drug availability and reimbursement situations in the individual participating Asian countries.
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Affiliation(s)
- T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - D Arnold
- CUF Hospitals Cancer Centre, Lisbon, Portugal
| | - H Taniguchi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - G Pentheroudakis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
| | - K Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - R-H Xu
- Department of Medical Oncology, Sun Yat-Sen University (SYSU) Cancer Center, Guangzhou, China
| | - T W Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - F Ismail
- Department of Radiotherapy & Oncology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - I B Tan
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - K-H Yeh
- Department of Oncology, National Taiwan University Hospital, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - A Grothey
- Division of Medical Oncology, Mayo Clinic Cancer Center, Rochester, USA
| | - S Zhang
- Cancer Institute, Zhejiang University, Hangzhou, China
| | - J B Ahn
- Division of Oncology, Department of Internal Medicine, Yonsei Cancer Center, Seoul, Korea
| | - M Y Mastura
- Pantai Cancer Institute, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - D Chong
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - L-T Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - S Kopetz
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Centre, Houston, USA
| | - T Eguchi-Nakajima
- Department of Clinical Oncology, School of Medicine, St. Marianna University, Kanagawa, Japan
| | - H Ebi
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - A Ohtsu
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - A Cervantes
- CIBERONC, Department of Medical Oncology, Institute of Health Research, INCLIVIA, University of Valencia, Valencia, Spain
| | - K Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - J Tabernero
- Medical Oncology Department, Vall d' Hebron University Hospital, Vall d'Hebron Institute of Oncology (V.H.I.O.), Barcelona, Spain
| | - H Minami
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - F Ciardiello
- Division of Medical Oncology, Seconda Università di Napoli, Naples, Italy
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Leimkühler M, Hemmer PHJ, Reyners AKL, de Groot DJA, van Ginkel RJ, Been LB, de Bock GH, van Leeuwen BL. Neoadjuvant chemotherapy followed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer: a feasibility and safety study. World J Surg Oncol 2019; 17:14. [PMID: 30635070 PMCID: PMC6330449 DOI: 10.1186/s12957-018-1554-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/27/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Standard treatment for colorectal peritoneal carcinomatosis typically involves cytoreductive surgery, hyperthermic intraperitoneal chemotherapy (HIPEC), and if possible, postoperative adjuvant chemotherapy. However, a substantial percentage of patients never receive adjuvant chemotherapy because of postoperative complications. Neoadjuvant chemotherapy could be beneficial in this setting, so we assessed its feasibility and safety when used before cytoreductive surgery and HIPEC. METHODS In this non-randomized, single-center, observational feasibility study, patients were scheduled to receive six cycles of capecitabine and oxaliplatin before cytoreductive surgery and HIPEC. Computed tomography was performed after the third and sixth chemotherapy cycles to evaluate tumor response, and patients underwent cytoreductive surgery and HIPEC if there were no pulmonary and/or hepatic metastases. Postoperative complications, graded according to the Clavien-Dindo classification, were compared with those of a historic control group that received postoperative adjuvant chemotherapy. RESULTS Of the 14 patients included in the study, 4 and 3 had to terminate neoadjuvant chemotherapy early because of toxicity and tumor progression, respectively. Cytoreductive surgery and HIPEC were performed in eight patients, and the timing and severity of complications were comparable to those of patients in the historic control group treated without neoadjuvant chemotherapy. CONCLUSION Patients with peritoneal metastases due to colorectal carcinoma can be treated safely with neoadjuvant chemotherapy before definitive therapy with cytoreductive surgery and HIPEC. TRIAL REGISTRATION NUMBER NTR 3905, registered on 20th march, 2013, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3905.
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Affiliation(s)
- M Leimkühler
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - P H J Hemmer
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
| | - A K L Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - D J A de Groot
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - R J van Ginkel
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - L B Been
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - B L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
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7
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Collard MK, Danion J, Cauchy F, Perdigao F, Leblanc S, Prat F, Soubrane O, Scatton O. Duct-To-Duct Biliary Anastomosis with Removable Internal Biliary Stent During Major Hepatectomy Extended to the Biliary Confluence. J Gastrointest Surg 2018; 22:2201-2208. [PMID: 30091039 DOI: 10.1007/s11605-018-3905-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/25/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Roux-en-Y hepaticojejunostomy (HJ) currently represents the gold standard after resection of the biliary confluence. This non-physiological reconstruction poses several problems such as repeated cholangitis or stricture without conventional endoscopic access. Our aim was to describe and to report both feasibility and results of duct-to-duct anastomosis with removable internal biliary drain (RIBS) as an alternative technique to the HJ after resection of the biliary confluence in patients undergoing major liver resection. METHODS Between January 2014 and January 2018, all patients who underwent a major hepatectomy associated with resection of the biliary confluence and reconstruction by duct-to-duct biliary anastomosis with RIBS were retrospectively included. Patient demographics, tumor characteristics, pre- and postoperative outcomes, early and late biliary complications, endoscopic complications, and clinical follow-up were collected. RESULTS Twelve patients were included. The operative time was 326 ± 45 min (range 240-380 min). There was no postoperative mortality. Only one patient experienced biliary anastomotic leakage treated exclusively by radiological and endoscopic drainage. Four patients had an asymptomatic stricture of the biliary anastomosis detected by endoscopic retrograde cholangiopancreatography (ERCP) during the extraction of the RIBS requiring iterative dilatation and replacement of the RIBS. Among 21 performed ERCP, no complications such as failure of RIBS extraction, duodenal perforation, bleeding after sphincterotomy, cholangitis, or pancreatitis were observed. After a mean and a median follow-up of respectively 15.0 ± 14.9 and 8.7 months (range 2.0-46.1 months), no cholangitis occurred. CONCLUSION Duct-to-duct biliary anastomosis with RIBS insertion after resection of the biliary confluence represents a feasible and safe alternative to the HJ.
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Affiliation(s)
- Maxime K Collard
- Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Jérôme Danion
- Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - François Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, AP-HP, 100, Boulevard du Général Leclerc, 92110, Clichy, France
| | - Fabiano Perdigao
- Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology and Endoscopy, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Frédéric Prat
- Department of Gastroenterology and Endoscopy, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.,Paris-V Descartes University, Paris, France
| | - Olivier Soubrane
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, AP-HP, 100, Boulevard du Général Leclerc, 92110, Clichy, France.,Paris-VII Diderot University, Paris, France
| | - Olivier Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. .,Sorbonne University, Paris, France.
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8
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Sakae H, Kanzaki H, Nasu J, Akimoto Y, Matsueda K, Yoshioka M, Nakagawa M, Hori S, Inoue M, Inaba T, Imagawa A, Takatani M, Takenaka R, Suzuki S, Fujiwara T, Okada H. The characteristics and outcomes of small bowel adenocarcinoma: a multicentre retrospective observational study. Br J Cancer 2017; 117:1607-1613. [PMID: 28982111 PMCID: PMC5729438 DOI: 10.1038/bjc.2017.338] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/23/2017] [Accepted: 09/01/2017] [Indexed: 12/15/2022] Open
Abstract
Background: Small bowel adenocarcinoma (SBA) is a rare malignancy that accounts for 1–2% of gastrointestinal tumours. We investigated the clinical characteristics, outcomes, and prognostic factors of primary SBA. Methods: We retrospectively analysed the characteristics and clinical courses of 205 SBA patients from 11 institutions in Japan between June 2002 and August 2013. Results: The primary tumour was in the duodenum and jejunum/ileum in 149 (72.7%) and 56 (27.3%) patients, respectively. Sixty-four patients (43.0%) with duodenal adenocarcinoma were asymptomatic and most cases were detected by oesophagogastroduodenoscopy (EGD), which was not specifically performed for the detection or surveillance of duodenal tumours. In contrast, 47 patients (83.9%) with jejunoileal carcinoma were symptomatic. The 3-year survival rate for stage 0/I, II, III, and IV cancers was 93.4%, 73.1%, 50.9%, and 15.1%, respectively. Multivariate analysis revealed performance status 3–4, high carcinoembryonic antigen, high lactate dehydrogenase (LDH), low albumin, symptomatic at diagnosis, and stage III/IV disease were independent factors for overall survival (OS). Ten patients (18.5%) with stage IV disease were treated with a combination of resection of primary tumour, local treatment of metastasis, and chemotherapy; this group had a median OS of 36.9 months. Conclusions: Although most SBA patients were diagnosed with symptomatic, advanced stage disease, some patients with duodenal carcinoma were detected in early stage by EGD. High LDH and symptomatic at diagnosis were identified as novel independent prognostic factors for OS. The prognosis of advanced SBA was poor, but combined modality therapy with local treatment of metastasis might prolong patient survival.
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Affiliation(s)
- Hiroyuki Sakae
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan
| | - Junichiro Nasu
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan.,Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-Ku, Okayama 700-8511, Japan
| | - Yutaka Akimoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Masao Yoshioka
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-Ku, Okayama 700-8511, Japan
| | - Masahiro Nakagawa
- Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-Ku, Hiroshima 730-8518, Japan
| | - Shinichiro Hori
- Department of Endoscopy, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Masafumi Inoue
- Department of Gastroenterology, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-Ku, Okayama 700-8607, Japan
| | - Tomoki Inaba
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, 5-4-6 Ban-cho, Takamatsu, Kagawa 760-8557, Japan
| | - Atsushi Imagawa
- Department of Gastroenterology, Mitoyo General Hospital, 708 Himehama, Kanonji, Kagawa 769-1695, Japan
| | - Masahiro Takatani
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, Hyogo 670-8540, Japan
| | - Ryuta Takenaka
- Department of Internal Medicine, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama 708-0848, Japan
| | - Seiyu Suzuki
- Department of Internal Medicine, Sumitomo Besshi Hospital, 3-1 Ouji-cho, Niihama, Ehime 792-8543, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan
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Use of Bevacizumab in the Management of Potentially Resectable Colorectal Liver Metastases: Safety, Pathologic Assessment and Benefit. CURRENT COLORECTAL CANCER REPORTS 2016. [DOI: 10.1007/s11888-016-0326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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10
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Donati M, Stavrou GA, Stang A, Basile F, Oldhafer KJ. "Liver-first" approach with ALPPS: The natural combination of two new concepts in liver surgery. Surg Oncol 2016; 25:278-80. [PMID: 27566034 DOI: 10.1016/j.suronc.2016.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Marcello Donati
- Department of Surgery and Medical-Surgical Specialties, General and Oncologic Surgery Unit, Vittorio-Emanuele University Hospital of Catania, Italy; Semmelweiss University of Budapest, Asklepios Campus Hamburg, Germany.
| | - Gregor A Stavrou
- Department of General and Abdominal Surgery, Asklepios Barmbek Hospital, Germany.
| | - Axel Stang
- Department of Oncology, Asklepios Barmbek Hospital, Hamburg, Germany.
| | - Francesco Basile
- Department of Surgery and Medical-Surgical Specialties, General and Oncologic Surgery Unit, Vittorio-Emanuele University Hospital of Catania, Italy.
| | - Karl J Oldhafer
- Department of General and Abdominal Surgery, Asklepios Barmbek Hospital, Germany; Semmelweiss University of Budapest, Asklepios Campus Hamburg, Germany.
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