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Ramia JM, Villodre C, Sánchez Pérez B, Falgueras Verdaguer L, Serradilla Martín M. Postoperative complications after liver-first Approach RENACI project. Cir Esp 2024:S2173-5077(24)00172-8. [PMID: 39059551 DOI: 10.1016/j.cireng.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024]
Affiliation(s)
- Jose M Ramia
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación ISABIAL, Alicante, Spain; Universidad Miguel Hernández, Elche, Spain
| | - Celia Villodre
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación ISABIAL, Alicante, Spain; Universidad Miguel Hernández, Elche, Spain
| | - Belinda Sánchez Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Laia Falgueras Verdaguer
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Dr. Josep Trueta, Girona, Spain
| | - Mario Serradilla Martín
- Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Departamento de Cirugía y sus Especialidades, Facultad de Medicina, Universidad de Granada, Granada, Spain.
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Hernandez MC, Fan D, Sandhu J, Mahuron K, Kessler J, Raoof M, Fakih M, Singh G, Fong Y, Melstrom LG. Recurrence patterns after complex multimodality therapy and hepatic arterial infusion for colorectal liver metastases: A reflection of biology and technique. J Surg Oncol 2024; 129:1254-1264. [PMID: 38505908 DOI: 10.1002/jso.27622] [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: 01/08/2024] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND AND METHODS We characterized colorectal liver metastasis recurrence and survival patterns after surgical resection and intraoperative ablation ± hepatic arterial infusion pump (HAIP) placement. We estimated patterns of recurrence and survival in patients undergoing contemporary multimodal treatments. Between 2017 and 2021, patient, tumor characteristics, and recurrence data were collected. Primary outcomes included recurrence patterns and survival data based on operative intervention. RESULTS There were 184 patients who underwent hepatectomy and intraoperative ablation. Sixty patients (32.6%) underwent HAIP placement. A total of 513 metastases were ablated, median total of 2 ablations per patient. Median time to recurrence was 31 [22-40] months. Recurrence patterns included tumor at ablative margin on first scheduled postoperative imaging (8, 4.3%), local tumor recurrence at ablative site (69, 37.5%), and non-ablated liver tumor recurrence (38, 20.6%). In patients who underwent HAIP placement, the rate of liver recurrence was reduced (45% vs 70.9%, p = 0.0001). Median overall survival was 64 [41-58] months and prolonged survival was associated with HAIP treatment (85 [66-109] vs 60 [51-70] months. CONCLUSIONS AND DISCUSSION Hepatic recurrence is common and combination of intraoperative ablation and HAIP treatments were associated with prolonged survival. These data may reflect patient selection however, future work will clarify preoperative tumor and patient characteristics that may better predict recurrence expectations.
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Affiliation(s)
- Matthew C Hernandez
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Darrell Fan
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Jaideep Sandhu
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Kelly Mahuron
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Jonathan Kessler
- Department of Radiology, City of Hope National Medical Center, Duarte, California, USA
| | - Mustafa Raoof
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Marwan Fakih
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Gagandeep Singh
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Yuman Fong
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Laleh G Melstrom
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California, USA
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Serradilla-Martín M, Villodre C, Falgueras-Verdaguer L, Zambudio-Carroll N, Castell-Gómez JT, Blas-Laina JL, Borrego-Estella V, Domingo-del-Pozo C, García-Plaza G, González-Rodríguez FJ, Montalvá-Orón EM, Moya-Herraiz Á, Paterna-López S, Suárez-Muñoz MA, Alkorta-Zuloaga M, Blanco-Fernández G, Dabán-Collado E, Gómez-Bravo MA, Miota-de-Llamas JI, Rotellar F, Sánchez-Pérez B, Sánchez-Cabús S, Pacheco-Sánchez D, Rodríguez-Sanjuan JC, Varona-Bosque MA, Carrión-Álvarez L, de la Serna-Esteban S, Dopazo C, Martín-Pérez E, Martínez-Cecilia D, Castro-Santiago MJ, Dorcaratto D, Gutiérrez-Díaz ML, Asencio-Pascual JM, Burdío-Pinilla F, Carracedo-Iglesias R, Escartín-Arias A, Ielpo B, Rodríguez-Laiz G, Valdivieso-López A, De-Vicente-López E, Alonso-Orduña V, Ramia JM. Feasibility and Short-Term Outcomes in Liver-First Approach: A Spanish Snapshot Study (the RENACI Project). Cancers (Basel) 2024; 16:1676. [PMID: 38730631 PMCID: PMC11082946 DOI: 10.3390/cancers16091676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: The liver-first approach may be indicated for colorectal cancer patients with synchronous liver metastases to whom preoperative chemotherapy opens a potential window in which liver resection may be undertaken. This study aims to present the data of feasibility and short-term outcomes in the liver-first approach. (2) Methods: A prospective observational study was performed in Spanish hospitals that had a medium/high-volume of HPB surgeries from 1 June 2019 to 31 August 2020. (3) Results: In total, 40 hospitals participated, including a total of 2288 hepatectomies, 1350 for colorectal liver metastases, 150 of them (11.1%) using the liver-first approach, 63 (42.0%) in hospitals performing <50 hepatectomies/year. The proportion of patients as ASA III was significantly higher in centers performing ≥50 hepatectomies/year (difference: 18.9%; p = 0.0213). In 81.1% of the cases, the primary tumor was in the rectum or sigmoid colon. In total, 40% of the patients underwent major hepatectomies. The surgical approach was open surgery in 87 (58.0%) patients. Resection margins were R0 in 78.5% of the patients. In total, 40 (26.7%) patients had complications after the liver resection and 36 (27.3%) had complications after the primary resection. One-hundred and thirty-two (89.3%) patients completed the therapeutic regime. (4) Conclusions: There were no differences in the surgical outcomes between the centers performing <50 and ≥50 hepatectomies/year. Further analysis evaluating factors associated with clinical outcomes and determining the best candidates for this approach will be subsequently conducted.
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Affiliation(s)
- Mario Serradilla-Martín
- Department of Surgery, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Department of Surgery, School of Medicine, University of Granada, 18016 Granada, Spain
| | - Celia Villodre
- Department of Surgery, Hospital General Universitario Dr. Balmis, 03010 Alicante, Spain; (C.V.); (J.M.R.)
- ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, 03010 Alicante, Spain
- Department of Surgery, Universidad Miguel Hernández, 03202 Alicante, Spain
| | | | | | | | | | | | | | - Gabriel García-Plaza
- Department of Surgery, Hospital Universitario Insular, 35016 Las Palmas de Gran Canaria, Spain;
| | | | - Eva M. Montalvá-Orón
- Department of Surgery, Hospital Universitario y Politécnico La Fe, IIS La Fe, Ciberehd ISCIII, 46026 Valencia, Spain;
| | - Ángel Moya-Herraiz
- Department of Surgery, Hospital Universitario de Castellón, 12004 Castelló de la Plana, Spain;
| | - Sandra Paterna-López
- Department of Surgery, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | - Miguel A. Suárez-Muñoz
- Department of Surgery, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain;
| | | | | | | | - Miguel A. Gómez-Bravo
- Department of Surgery, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain;
| | | | - Fernando Rotellar
- Department of Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
| | - Belinda Sánchez-Pérez
- Department of Surgery, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain;
| | - Santiago Sánchez-Cabús
- Department of Surgery, Hospital Universitario de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | | | | | - María A. Varona-Bosque
- Department of Surgery, Hospital Universitario Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain;
| | | | | | - Cristina Dopazo
- Department of Surgery, Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain;
| | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario La Princesa, 28006 Madrid, Spain; (E.M.-P.); (D.M.-C.)
| | - David Martínez-Cecilia
- Department of Surgery, Hospital Universitario La Princesa, 28006 Madrid, Spain; (E.M.-P.); (D.M.-C.)
- Department of Surgery, Hospital Universitario Virgen de la Salud, 45004 Toledo, Spain
| | | | - Dimitri Dorcaratto
- Department of Surgery, Hospital Clínico Universitario, 46010 Valencia, Spain;
| | | | | | - Fernando Burdío-Pinilla
- Department of Surgery, Hospital Universitario del Mar, 08003 Barcelona, Spain; (F.B.-P.); (B.I.)
| | | | | | - Benedetto Ielpo
- Department of Surgery, Hospital Universitario del Mar, 08003 Barcelona, Spain; (F.B.-P.); (B.I.)
- Department of Surgery, Hospital Universitario de León, 24008 León, Spain
| | - Gonzalo Rodríguez-Laiz
- Department of Surgery, Hospital General Universitario Dr. Balmis, 03010 Alicante, Spain; (C.V.); (J.M.R.)
| | | | | | - Vicente Alonso-Orduña
- Department of Medical Oncology, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | - José M. Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, 03010 Alicante, Spain; (C.V.); (J.M.R.)
- ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, 03010 Alicante, Spain
- Department of Surgery, Universidad Miguel Hernández, 03202 Alicante, Spain
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Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2). Cancers (Basel) 2022; 14:cancers14174190. [PMID: 36077728 PMCID: PMC9454893 DOI: 10.3390/cancers14174190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM) was a propensity score matched (PSM) study that reported short-term outcomes of patients with CRLM who met the Milan criteria and underwent either open (OLR), laparoscopic (LLR) or robotic liver resection (RLR). This study, designated as SIMMILR-2, reports the long-term outcomes from that initial study, now referred to as SIMMILR-1. Methods: Data regarding neoadjuvant chemotherapeutic (NC) and neoadjuvant biological (NB) treatments received were collected, and Kaplan−Meier curves reporting the 5-year overall (OS) and recurrence-free survival (RFS) for OLR, LLR and RLR were created for patients who presented with synchronous lesions only, as there was insufficient follow-up for patients with metachronous lesions. Results: A total of 73% of patients received NC and 38% received NB in the OLR group compared to 70% and 28% in the LLR group, respectively (p = 0.5 and p = 0.08). A total of 82% of patients received NC and 40% received NB in the OLR group compared to 86% and 32% in the RLR group, respectively (p > 0.05). A total of 71% of patients received NC and 53% received NB in the LLR group compared to 71% and 47% in the RLR group, respectively (p > 0.05). OS at 5 years was 34.8% after OLR compared to 37.1% after LLR (p = 0.4), 34.3% after OLR compared to 46.9% after RLR (p = 0.4) and 30.3% after LLR compared to 46.9% after RLR (p = 0.9). RFS at 5 years was 12.1% after OLR compared to 20.7% after LLR (p = 0.6), 33.3% after OLR compared to 26.3% after RLR (p = 0.6) and 22.7% after LLR compared to 34.6% after RLR (p = 0.6). Conclusions: When comparing OLR, LLR and RLR, the OS and RFS were all similar after utilization of the Milan criteria and PSM. Biological agents tended to be utilized more in the OLR group when compared to the LLR group, suggesting that highly aggressive tumors are still managed through an open approach.
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Aliyev SA, Aliyev ES. [Colorectal cancer liver metastases: current state of the problem, priority treatment approaches]. Khirurgiia (Mosk) 2022:111-119. [PMID: 35593635 DOI: 10.17116/hirurgia2022051111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review is devoted to the world trends in epidemiology of colorectal cancer and treatment of colorectal cancer liver metastases. The authors analyze the effectiveness of traditional (resection) and modern minimally invasive methods of local destruction (radiofrequency thermoablation, microwave ablation, cryoablation), stereotactic radiotherapy, radiosurgery, targeted therapy and endovascular techniques (chemoinfusion, chemoembolization, radioembolization). It was emphasized that searching for new chemotherapeutic and targeted drugs is one of the reserve ways to improve treatment outcomes in patients with potentially resectable colorectal cancer liver metastases. The possibilities and prospects of liver transplantation as a priority treatment strategy for patients with unresectable bilobar colorectal cancer liver metastases are highlighted.
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Affiliation(s)
- S A Aliyev
- Azerbaijan Medical University, Baku, Azerbaijan
| | - E S Aliyev
- Azerbaijan Medical University, Baku, Azerbaijan
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Karam E, Bucur P, Gil C, Sindayigaya R, Tabchouri N, Barbier L, Pabst-Giger U, Bourlier P, Lecomte T, Moussata D, Chapet S, Calais G, Ouaissi M, Salamé E. Simultaneous or staged resection for synchronous liver metastasis and primary rectal cancer: a propensity score matching analysis. BMC Gastroenterol 2022; 22:201. [PMID: 35448953 PMCID: PMC9026992 DOI: 10.1186/s12876-022-02250-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background Colorectal cancer is the third most common cancer in France and by the time of the diagnosis, 15–25% of patients will suffer from synchronous liver metastases. Surgery associated to neoadjuvant treatment can cure these patients, but few studies focus only on rectal cancer. This study was meant to compare the outcomes of patients who underwent a simultaneous resection to those who underwent a staged resection (rectum first or liver first) in the University Hospital of Tours, France. Methods We assessed retrospectively a prospective maintained data base about the clinical, pathological and survival outcomes of patients who underwent a simultaneous or a staged resection in our center between 2010 and 2018. A propensity score matching was used, considering the initial characteristics of our groups. Results There were 70 patients (55/15 males, female respectively) with median age 60 (54–68) years. After matching 48 (69%) of them underwent a staged approach and 22 (31%) a simultaneous approach were compared. After PSM, there were 22 patients in each group. No differences were found in terms of morbidity (p = 0.210), overall survival (p = 0.517) and disease-free survival (p = 0.691) at 3 years after matching. There were significantly less recurrences in the simultaneous group (50% vs 81.8%, p = 0.026). Conclusions Simultaneous resection of the rectal primary cancer and synchronous liver metastases is safe and feasible with no difference in terms of survival. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02250-9.
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Affiliation(s)
- Elias Karam
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Petru Bucur
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Camille Gil
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Remy Sindayigaya
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Nicolas Tabchouri
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Louise Barbier
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Urs Pabst-Giger
- EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France
| | - Pascal Bourlier
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Trousseau Hospital, Chambray les Tours, France
| | - Driffa Moussata
- Department of Hepatogastroenterology and Digestive Oncology, Trousseau Hospital, Chambray les Tours, France
| | - Sophie Chapet
- Department of Radiotherapy, Bretonneau Hospital, Tours, France
| | - Gilles Calais
- Department of Radiotherapy, Bretonneau Hospital, Tours, France
| | - Mehdi Ouaissi
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France.
| | - Ephrem Salamé
- Colorectal Surgery Unit, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Avenue de La République, Chambray les Tours, France
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Engstrand J, Sterner J, Hasselgren K, Stromberg C, Sturesson C. Treatment intention and outcome in patients with simultaneously diagnosed liver and lung metastases from colorectal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1799-1806. [DOI: 10.1016/j.ejso.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 12/13/2022]
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Current Surgical Management Strategies for Colorectal Cancer Liver Metastases. Cancers (Basel) 2022; 14:cancers14041063. [PMID: 35205811 PMCID: PMC8870224 DOI: 10.3390/cancers14041063] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Colorectal cancer is one of the most common cancer diagnoses in the world. At least half of patients diagnosed with colorectal cancer will develop metastatic disease, with most being identified in the liver. Surgical resection of colorectal liver metastases (CRLM) is potentially curative. Surgical resection of CRLM, however, remains underutilized despite the continued expansion of operative strategies available. This is likely due to differing views on resectability. Resectability is a surgical assessment, and the classification of CRLM as unresectable should only be made by an experienced hepatobiliary surgeon. Obtaining a surgical evaluation at the time of liver metastasis discovery may help mitigate the challenge of assessing resectability and the determination of potential operative time windows within current multimodal management strategies. The aim of this review is to help facilitate discussions surrounding resectability as well as the timing and sequencing of both surgical and non-surgical therapies. Abstract Colorectal cancer is the third most common cancer diagnosis in the world, and the second most common cause of cancer-related deaths. Despite significant progress in management strategies for colorectal cancer over the last several decades, metastatic disease remains difficult to treat and is often considered incurable. However, for patients with colorectal liver metastases (CRLM), surgical resection offers the best opportunity for survival, can be curative, and remains the gold standard. Unfortunately, surgical treatment options are underutilized. Misperceptions regarding resectable and unresectable CRLM likely play a role in this. The assessment of factors that impact resectability status like medical fitness, technical considerations, and disease biology can be difficult, necessitating careful multidisciplinary input and discussion. The identification of ideal operative time windows that align with the multimodal management of these patients can also be perplexing. For all patients with CRLM it may therefore be advantageous to obtain surgical evaluation at the time of discovering liver metastases to mitigate these challenges and minimize the risk of undertreatment. In this review we summarize current surgical management strategies for CRLM and discuss factors to be considered when determining resectability.
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Chan AKC, Mason JM, Baltatzis M, Siriwardena AK. Management of Colorectal Cancer with Synchronous Liver Metastases: An Inception Cohort Study (CoSMIC). Ann Surg Oncol 2021; 29:1939-1951. [PMID: 34716838 DOI: 10.1245/s10434-021-11017-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/12/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Approximately one-fifth of patients with colorectal cancer present with hepatic metastases. There are limited prospective data on the outcomes of synchronous combined liver and bowel surgery and liver-first or bowel-first routes where contemporary chemo(radio)therapy is integrated into management. METHODS Between 1 April 2014 and 31 March 2017, 125 patients with colorectal cancer and synchronous liver metastases were recruited. Data are reported on pathway-specific outcomes, including perioperative complications, treatment completion, and overall and disease-free survival. The study was registered with ClinicalTrials.gov (NCT02456285). RESULTS There was no difference in age, body mass index, or Charlson score between surgical groups. Neoadjuvant chemotherapy was used in 50 (40%) patients for a mean duration of 4.6 months (standard deviation [SD] 5.4), and mean time from completion of chemotherapy to surgery was 2.6 months (SD 1.9). Complications were similar between patients completing the synchronous and staged pathways (p = 0.66). Mean total inpatient stay was 16.5 days (SD 8.1) for staged surgery compared with 16.8 days (SD 10.3) for the synchronous group (t-test; p = 0.91). There was no difference in time to treatment completion between pathways. Thirty six (35%) patients were disease-free at 12 months, with no significant difference between groups (Chi-square, p = 0.448). Quality of life was similar in all surgical groups. CONCLUSIONS Perioperative complications and oncological and healthcare occupancy outcomes are equivalent between patients completing staged and synchronous pathways for the management of patients with colorectal cancer and synchronous liver metastases. Future studies should focus on optimizing the criteria for pathway selection, incorporation of cancer genomics data, and patient (user) preferences.
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Affiliation(s)
- Anthony K C Chan
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - James M Mason
- Warwick Medical School, The University of Warwick, Coventry, UK
| | - Minas Baltatzis
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Ajith K Siriwardena
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK. .,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Zeyara A, Torén W, Søreide K, Andersson R. The liver-first approach for synchronous colorectal liver metastases: A systematic review and meta-analysis of completion rates and effects on survival. Scand J Surg 2021; 111:14574969211030131. [PMID: 34605325 DOI: 10.1177/14574969211030131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients presenting with synchronous colorectal liver metastases are increasingly being considered for a curative treatment, and the liver-first approach is gaining popularity in this context. However, little is known about the completion rates of the liver-first approach and its effects on survival. METHODS A systematic review and meta-analysis of liver-first strategy for colorectal liver metastasis. The primary outcome was an assessment of the completion rates of the liver-first approach. Secondary outcomes included overall survival, causes of non-completion, and clinicopathologic data. RESULTS Seventeen articles were amenable for inclusion and the total study population was 1041. The median completion rate for the total population was 80% (range 20-100). The median overall survival for the completion and non-completion groups was 45 (range 12-69) months and 13 (range 10.5-25) months, respectively. Metadata showed a significant survival benefit for the completion group, with a univariate hazard ratio of 12.0 (95% confidence interval, range 5.7-24.4). The major cause of non-completion (76%) was liver disease progression before resection of the primary tumor. Pearson tests showed significant negative correlation between median number of lesions and median size of the largest metastasis and completion rate. CONCLUSIONS The liver-first approach offers a complete resection to most patients enrolled, with an overall survival benefit when completion can be assured. One-fifth fails to return to intended oncologic therapy and the major cause is interim metastatic progression, most often in the liver. Risk of non-completion is related to a higher number of lesions and large metastases. The majority of studies stem from primary rectal cancers, which may influence on the return to intended oncologic therapy as well.PROSPERO id no: 170459.
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Affiliation(s)
- Adam Zeyara
- Department of Surgery, Ystad Hospital, Ystad, Sweden Department of Clinical Sciences, Lund University, Lund, Sweden
| | - William Torén
- Department of Clinical Sciences, Lund University, Lund, Sweden Department of Surgery, Skåne University Hospital, Lund, SwedenKjetil Søreide
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Roland Andersson
- Department of Surgery, Skåne University Hospital, Lund SE-222 42, Sweden
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Bae HW, Kim HS, Yang SY, Kim HS, Shin SJ, Chang JS, Koom WS, Kim NK. Upfront chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer with synchronous liver metastases. Eur J Surg Oncol 2021; 47:2814-2820. [PMID: 34024668 DOI: 10.1016/j.ejso.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/28/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The optimal treatment of locally advanced rectal cancer with synchronous liver metastases remains controversial. In this study, we aimed to evaluate the safety, efficacy, and oncologic outcomes of upfront chemotherapy and short-course radiotherapy with delayed surgery in patients with locally advanced rectal cancer and synchronous liver metastases. METHODS Forty-four patients who underwent upfront chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer (cT3/4, <2.0 mm from the mesorectal fascia) with synchronous liver metastases between January 2010 and June 2017 were reviewed retrospectively. Primary and metastatic liver lesions were resected with curative intent. Upfront chemotherapy and short-course radiotherapy were administered. Thereafter, restaging, surgery only, or additional chemotherapy followed by surgery was performed. RESULTS At the time of initial diagnosis, 20 patients had <3 liver metastases; 24 patients had ≥3 liver metastases. Twenty-three patients had hemi-liver metastases; 21 patients had bilobar liver metastases. R0 resection of rectal lesions was achieved in 43 patients. Synchronous R0 resection of liver metastases was achieved in 41 patients. Postoperative complications (Clavien-Dindo Grade ≥ III) were noted in 5 patients. Grade 3/4 adverse events were observed in 26 patients. All adverse events were managed effectively with medication and supportive care. The 3-year overall survival and progression-free survival rates were 65.3% and 26.9%, respectively. CONCLUSION Upfront chemotherapy and short-course radiotherapy with delayed surgery appear to be safe and effective in patients with locally advanced rectal cancer and synchronous liver metastases without substantially increasing treatment induced morbidity.
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Affiliation(s)
- Hyeon Woo Bae
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Ho Seung Kim
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Yoon Yang
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Han Sang Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Nam Kyu Kim
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
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12
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Perfecto A, Gastaca M, Prieto M, Cervera J, Ruiz P, Ventoso A, Palomares I, García JM, Valdivieso A. Totally laparoscopic simultaneous resection of colorectal cancer and synchronous liver metastases: a single-center case series. Surg Endosc 2021; 36:980-987. [PMID: 33666752 DOI: 10.1007/s00464-021-08362-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aim of the study is to analyze the feasibility, the safety and short- and medium-term survival of totally laparoscopic simultaneous resections (LSR) of colorectal cancer (CRC) and synchronous liver metastases (LM). METHODS This is a retrospective study of a single-center series. Patients ASA IV, ECOG ≥ 2, major hepatectomies (≥ 3 segments), symptomatic CRC as well as low rectal tumors were excluded from indication. The difficulty level of all liver resections was classified as low or intermediate according to the Iwate Criteria. Dindo-Clavien classification for postoperative complications evaluation was used. RESULTS 15 Patients with 21 liver lesions were included. Laparoscopic liver surgery was performed first in every case. Median size of the lesions was 20 mm (r 8-69). Major complications (Dindo-Clavien ≥ 3) occurred in 3 patients (20%); median hospital stay was 7 days (r 4-35), and only one patient (6.6%) was readmitted upon the first month from the surgery. 90-day mortality rate was 0%. After a median follow-up of 24 months (r 7-121), disease-free survival at 1, 2 and 3 years was 58%, 36% and 24%, respectively; overall survival at 1, 2 and 3 years was 92.3%. CONCLUSIONS In selected patients, LSR of CRC and LM is technically feasible and has an acceptable morbidity rate and mid-term survival.
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Affiliation(s)
- Arkaitz Perfecto
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Plaza Cruces S/N, Barakaldo, 48903, Spain
| | - Mikel Gastaca
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Plaza Cruces S/N, Barakaldo, 48903, Spain. .,University of the Basque Country, Leioa, Spain.
| | - Mikel Prieto
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Plaza Cruces S/N, Barakaldo, 48903, Spain.,University of the Basque Country, Leioa, Spain
| | - Jorge Cervera
- University of the Basque Country, Leioa, Spain.,Coloproctology Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Plaza Cruces S/N, Barakaldo, 48903, Spain
| | - Patricia Ruiz
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Plaza Cruces S/N, Barakaldo, 48903, Spain
| | - Alberto Ventoso
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Plaza Cruces S/N, Barakaldo, 48903, Spain
| | - Ibone Palomares
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Plaza Cruces S/N, Barakaldo, 48903, Spain
| | - José María García
- University of the Basque Country, Leioa, Spain.,Coloproctology Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Plaza Cruces S/N, Barakaldo, 48903, Spain
| | - Andrés Valdivieso
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Plaza Cruces S/N, Barakaldo, 48903, Spain.,University of the Basque Country, Leioa, Spain
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13
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Sebastián-Tomás JC, Domingo-Del Pozo C, Gómez-Abril SÁ, Navarro-Martínez S, Ortiz-Tarín I, Torres-Sánchez T, Martínez-Blasco A, Martínez-Pérez A. Laparoscopic staged colon-first resection for metastatic colorectal cancer: Perioperative and midterm outcomes from a single-center experience. J Surg Oncol 2020; 122:1453-1461. [PMID: 32779218 DOI: 10.1002/jso.26152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/26/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The present study aimed to evaluate the short- and mid-term outcomes of laparoscopic colon-first staged resection for colorectal cancer (CRC) and colorectal cancer liver metastases (CRCLM). METHODS This study included patients with metastatic CRC who underwent laparoscopic surgical staged resection for the primary tumor and CRCLM between June 2013 and December 2018. Data collection included the baseline patient's and tumor features, the perioperative and histopathologic outcomes from both surgical procedures, and the oncologic follow-up. RESULTS Twenty-five patients were eligible for the study. Three major and 22 minor laparoscopic liver resections were performed following laparoscopic CRC surgery. Five patients required conversion to laparotomy during CRCLM resection, but no conversion was needed for the colorectal procedures. The rate of severe intraoperative complications (CLASSIC grade III-IV) was 8% and 16% during CRC and CRCLM resection, respectively. Three patients (12%) developed major postoperative complications (Clavien-Dindo grade > III) after both interventions, including one death due to intraoperative bleeding. During a median follow-up of 30 months, 15 patients were diagnosed with disease recurrence. The 3-year disease-free survival and overall survival were 33.3% and 73.9%, respectively. CONCLUSIONS Laparoscopic staged resection for CRC and CRCLM is safe, feasible, and offers acceptable midterm oncological outcomes in patients with metastatic colorectal cancer.
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Affiliation(s)
| | - Carlos Domingo-Del Pozo
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | | | - Sergio Navarro-Martínez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Inmaculada Ortiz-Tarín
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Teresa Torres-Sánchez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Amparo Martínez-Blasco
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Aleix Martínez-Pérez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
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Implementation and first results of a mandatory, nationwide audit on liver surgery. HPB (Oxford) 2019; 21:1400-1410. [PMID: 30926330 DOI: 10.1016/j.hpb.2019.02.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/28/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Dutch Hepato Biliary Audit (DHBA) was initiated in 2013 to assess the national quality of liver surgery. This study aimed to describe the initiation and implementation of this audit along with an overview of the results and future perspectives. METHODS Registry of patients undergoing liver surgery for all primary and secondary liver tumors in the DHBA is mandatory. Weekly, benchmarked information on process and outcome measures is reported to surgical teams. In this study, the first results of patients with colorectal liver metastases were presented, including results of data verification. RESULTS Between 2014 and 2017, 6241 procedures were registered, including 4261 (68%) resections for colorectal liver metastases. For minor- and major liver resections for colorectal liver metastases, the median [interquartile range] hospital stay was 6 [4-8] and 8 [6-12] days, respectively. A postoperative complicated course (complication leading to >14 days of hospital stay, reintervention or death) occurred in 26% and 43% and the 30-day/in-hospital mortality was 1% and 4%, respectively. The completeness of data was 97%. In 3.6% of patients, a complicated postoperative course was erroneously omitted. CONCLUSION Nationwide implementation of the DHBA has been successful. This was the first step in creating a complete evaluation of the quality of liver surgery.
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Krell RW, D'Angelica MI. Treatment sequencing for simultaneous colorectal liver metastases. J Surg Oncol 2019; 119:583-593. [DOI: 10.1002/jso.25424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/08/2019] [Indexed: 12/20/2022]
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Chow FCL, Chok KSH. Colorectal liver metastases: An update on multidisciplinary approach. World J Hepatol 2019; 11:150-172. [PMID: 30820266 PMCID: PMC6393711 DOI: 10.4254/wjh.v11.i2.150] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/24/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
Liver metastasis is the commonest form of distant metastasis in colorectal cancer. Selection criteria for surgery and liver-directed therapies have recently been extended. However, resectability remains poorly defined. Tumour biology is increasingly recognized as an important prognostic factor; hence molecular profiling has a growing role in risk stratification and management planning. Surgical resection is the only treatment modality for curative intent. The most appropriate surgical approach is yet to be established. The primary cancer and the hepatic metastasis can be removed simultaneously or in a two-step approach; these two strategies have comparable long-term outcomes. For patients with a limited future liver remnant, portal vein embolization, combined ablation and resection, and associating liver partition and portal vein ligation for staged hepatectomy have been advocated, and each has their pros and cons. The role of neoadjuvant and adjuvant chemotherapy is still debated. Targeted biological agents and loco-regional therapies (thermal ablation, intra-arterial chemo- or radio-embolization, and stereotactic radiotherapy) further improve the already favourable results. The recent debate about offering liver transplantation to highly selected patients needs validation from large clinical trials. Evidence-based protocols are missing, and therefore optimal management of hepatic metastasis should be personalized and determined by a multi-disciplinary team.
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Affiliation(s)
| | - Kenneth Siu-Ho Chok
- Department of Surgery and State Key Laboratory for Liver Research, the University of Hong Kong, Hong Kong, China
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