1
|
Raschzok N, Moosburner S, Blank M, Krenzien F, Lurje G, Schöning W, Sauer IM, Pratschke J, Modest DP, Kurreck A. Is interval chemotherapy safe and does it improve the outcome of patients with colorectal liver metastases undergoing multimodal two-stage hepatectomy? - A systematic literature review. BMC Cancer 2024; 24:1260. [PMID: 39390396 PMCID: PMC11465852 DOI: 10.1186/s12885-024-13008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 09/30/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Multimodal two-stage hepatectomy (mTSH) is used in patients with bilobar colorectal liver metastases (CRLM) that cannot be treated with one surgical procedure due to insufficient future liver remnant. Interval chemotherapy has been proposed to improve disease control in CRLM patients undergoing mTSH. We here present a narrative review of clinical studies on mTSH including the use of interval chemotherapy in patients with CRLM. METHODS A systematic literature search of the PubMed databases as well as the ClinicalTrials.gov registry was performed. RESULTS The use of interval chemotherapy during mTSH was reported in 23 studies and applied in 595 out of 1,461 patients with CRLM. Two studies report on the actual effects of this treatment, one study describes a trend towards improved disease progression rate. No serious adverse events caused by interval chemotherapy were observed. There is currently no randomized clinical trial investigating the efficacy and safety of interval chemotherapy during mTSH. CONCLUSION The currently available data indicate that interval chemotherapy does neither impair liver hypertrophy during mTSH nor cause procedure-associated complications in patients with CRLM. Results from randomized clinical trials on the potential positive effect on disease control are not yet available.
Collapse
Affiliation(s)
- Nathanael Raschzok
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Clinician Scientist Program, Berlin, Germany.
| | - Simon Moosburner
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Clinician Scientist Program, Berlin, Germany
| | - Moritz Blank
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Clinician Scientist Program, Berlin, Germany
| | - Georg Lurje
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Igor M Sauer
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dominik P Modest
- Department of Hematology, Oncology, and Cancer Immunology (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Annika Kurreck
- Department of Hematology, Oncology, and Cancer Immunology (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
2
|
Shimizu T, Aoki T, Ishizuka M, Sakamoto K, Beppu T, Honda G, Kotake K, Yamamoto M, Takahashi K, Endo I, Hasegawa K, Itabashi M, Hashiguchi Y, Kotera Y, Kobayashi S, Yamaguchi T, Natsume S, Tabuchi K, Kobayashi H, Yamaguchi K, Tani K, Morita S, Miyazaki M, Sugihara K, Ajioka Y. Evaluation of two-stage hepatectomy using portal vein embolization for colorectal liver metastasis: a retrospective nationwide cohort survey in Japan. Int J Surg 2024; 110:01279778-990000000-01667. [PMID: 38869986 PMCID: PMC11486952 DOI: 10.1097/js9.0000000000001811] [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: 01/24/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Two-stage hepatectomy (TSH) enables patients to undergo surgery for colorectal liver metastasis (CRLM) which one-stage hepatectomy cannot remove. Although the outcome of TSH has been reported, there is no original report from Japan. The aim of this retrospective study was to evaluate the outcome of TSH in Japanese patients with CRLM. METHODS We conducted a retrospective cohort study using the nationwide database that included clinical information of 12,519 patients treated with CRLM between 2005 and 2017 in Japan. The primary outcome measure was overall survival. The second outcome measure was progression-free survival. Fisher's exact test, chi-squared test and Mann-Whitney U test were conducted to examine an intergroup difference. Univariate and multivariate analyses were performed using Cox regression model. Survival analysis was performed by Kaplan-Meier method and log-rank test. RESULTS Of the database, 53 patients undergoing TSH using portal vein embolization (PVE) were identified and analyzed. Their morbidity and in-hospital mortality rate at the second hepatectomy were 26.4% and 0.0%. The mean observation period was 21.8 months. The estimated 1-, 3- and 5-year overall survival rate were 92.5%, 70.8% and 34.7%. Multivariate analyses showed that more than 10 liver nodules significantly increased the mortality risk by 4.2-fold (95%CI 1.224-14.99, P= 0.023). Survival analysis revealed that repeat hepatectomy for disease progression after TSH was superior to chemotherapy in overall survival (mean: 49.6 vs. 18.7, months, P= 0.004). CONCLUSION In the Japanese cohort, TSH was confirmed to be a safety procedure with acceptable survival outcome. More than 10 liver nodules may be a predictor for unfavorable outcome of patients with CRLM undergoing TSH. Furthermore, repeat hepatectomy can be a salvage treatment for resectable intrahepatic recurrence after TSH.
Collapse
Affiliation(s)
- Takayuki Shimizu
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi
| | - Taku Aoki
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi
| | - Mitsuru Ishizuka
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi
| | - Katsunori Sakamoto
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime
| | - Toru Beppu
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Surgery, Yamaga City Medical Center, Kumamoto
| | - Goro Honda
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical, Tochigi
| | - Kenjiro Kotake
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Surgery, Sano City Hospital, Sano, Tochigi
| | - Masakazu Yamamoto
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Surgery, Utsunomiya Memorial Hospital, Utsunomiya, Tochigi
| | - Keiichi Takahashi
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, Tokyo
| | - Itaru Endo
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa
| | - Kiyoshi Hasegawa
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, Graduate School of Medicine, The University of Tokyo
| | - Michio Itabashi
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical, Tochigi
| | - Yojiro Hashiguchi
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Surgery, Teikyo University School of Medicine Tokyo
| | - Yoshihito Kotera
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical, Tochigi
| | - Shin Kobayashi
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba
| | - Tatsuro Yamaguchi
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo
| | - Soichiro Natsume
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo
| | - Ken Tabuchi
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Pediatrics, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo
| | - Hirotoshi Kobayashi
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Surgery, Teikyo University Hospital, Kanagawa
| | - Kensei Yamaguchi
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Gastrointestinal Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo
| | - Kimitaka Tani
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical, Tochigi
| | - Satoshi Morita
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto
| | - Masaru Miyazaki
- International University of Health and Welfare, Narita Hospital, Tokyo
| | | | - Yoichi Ajioka
- Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| |
Collapse
|
3
|
Araujo RLC, Carvalho CGCY, Maeda CT, Milani JM, Bugano DG, de Moraes PHZ, Linhares MM. Oncologic aspects of the decision-making process for surgical approach for colorectal liver metastases progressing during chemotherapy. World J Gastrointest Surg 2022; 14:877-886. [PMID: 36185562 PMCID: PMC9521463 DOI: 10.4240/wjgs.v14.i9.877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/27/2022] [Accepted: 08/18/2022] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer represents the third most diagnosed malignancy in the world. The liver is the main site of metastatic disease, affected in 30% of patients with newly diagnosed disease. Complete resection is considered the only potentially curative treatment for colorectal liver metastasis (CRLM), with a 5-year survival rate ranging from 35% to 58%. However, up to 80% of patients have initially unresectable disease, due to extrahepatic disease or bilobar multiple liver nodules. The availability of increasingly effective systemic chemotherapy has contributed to converting patients with initially unresectable liver metastases to resectable disease, improving long-term outcomes, and accessing tumor biology. In recent years, response to preoperative systemic chemotherapy before liver resection has been established as a major prognostic factor. Some studies have demonstrated that patients with regression of hepatic metastases while on chemotherapy have improved outcomes when compared to patients with stabilization or progression of the disease. Even if disease progression during chemotherapy represents an independent negative prognostic factor, some patients may still benefit from surgery, given the role of this modality as the main treatment with curative intent for patients with CRLM. In selected cases, based on size, the number of lesions, and tumor markers, surgery may be offered despite the less favorable prognosis and as an option for non-chemo responders.
Collapse
Affiliation(s)
- Raphael L C Araujo
- Department of Surgery, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
- Department of Oncology, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
- Department of Surgical Oncology, Hospital e Maternidade Brasil Rede D'Or São Luiz, Santo André 09030-590, São Paulo, Brazil
| | - Camila G C Y Carvalho
- Department of Surgical Oncology, Hospital e Maternidade Brasil Rede D'Or São Luiz, Santo André 09030-590, São Paulo, Brazil
| | - Carlos T Maeda
- Department of Surgery, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
| | - Jean Michel Milani
- Department of Surgery, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
| | - Diogo G Bugano
- Department of Oncology, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | | | - Marcelo M Linhares
- Department of Surgery, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
| |
Collapse
|
4
|
Imai K, Allard M, Baba H, Adam R. Optimal patient selection for successful two-stage hepatectomy of bilateral colorectal liver metastases. Ann Gastroenterol Surg 2021; 5:634-638. [PMID: 34585048 PMCID: PMC8452472 DOI: 10.1002/ags3.12465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 12/13/2022] Open
Abstract
Two-stage hepatectomy (TSH) is one of the specific surgical techniques that can expand the pool of resectable patients with initially unresectable colorectal liver metastases (CRLM). The indication of TSH for CRLM is only bilateral, multinodular disease, which cannot be resected by a single hepatectomy. TSH is nowadays considered an effective treatment for selected patients, with acceptable morbidity/mortality rates and promising long-term outcomes. However, not all eligible patients can benefit from the TSH strategy. One of the most important issues is dropout from the strategy (failure to complete both of the two sequential procedures), because the survival of such patients is drastically worse compared with patients who can complete both stages. Another important issue is the early recurrence rate and subsequent poor survival even after completion of TSH. Thus, the selection of appropriate patients who can really benefit from the TSH strategy is crucial. This review discusses the optimal patient selection for TSH, which should be helpful for the development of treatment strategies for patients with extensive CRLM.
Collapse
Affiliation(s)
- Katsunori Imai
- Centre Hépato‐BiliaireAP‐HPHôpital Universitaire Paul BrousseVillejuifFrance
- Department of Gastroenterological SurgeryGraduate School of Life SciencesKumamoto UniversityKumamotoJapan
| | - Marc‐Antoine Allard
- Centre Hépato‐BiliaireAP‐HPHôpital Universitaire Paul BrousseVillejuifFrance
| | - Hideo Baba
- Department of Gastroenterological SurgeryGraduate School of Life SciencesKumamoto UniversityKumamotoJapan
| | - René Adam
- Centre Hépato‐BiliaireAP‐HPHôpital Universitaire Paul BrousseVillejuifFrance
| |
Collapse
|