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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: 23] [Impact Index Per Article: 11.5] [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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Hellingman T, de Swart ME, Heymans MW, Jansma EP, van der Vliet HJ, Kazemier G. Repeat hepatectomy justified in patients with early recurrence of colorectal cancer liver metastases: A systematic review and meta-analysis. Cancer Epidemiol 2021; 74:101977. [PMID: 34303642 DOI: 10.1016/j.canep.2021.101977] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/04/2021] [Accepted: 06/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The benefit of repeat hepatectomy in patients with early recurrence of colorectal cancer liver metastases (CRLM) is questioned, in particular in those suffering from recurrence within three to six months following initial hepatectomy. The aim of this review was therefore to assess whether disease-free interval was associated with overall survival in patients undergoing repeat hepatectomy for recurrent CRLM. METHODS A systematic review and meta-analysis was conducted, according to PRISMA guidelines. PubMed, Embase and Cochrane Library databases were searched from database inception to 6th June 2020. Observational studies describing results of repeat hepatectomy for recurrent CRLM, including (disease-free) interval between hepatic resections and overall survival were included. Patients undergoing repeat hepatectomy within three months or additional resection of extrahepatic disease were excluded from meta-analysis. RESULTS The initial search identified 2159 records, of which 28 were included for qualitative synthesis. A meta-analysis of 15 cohort studies was performed, comprising 1039 eligible patients. Median overall survival of 54.0 months [95 %-CI: 38.6-69.4] was observed after repeat hepatectomy in patients suffering from recurrent CRLM between three to six months compared to 53.0 months [95 %-CI: 44.3-61.6] for patients with recurrent CRLM between seven to twelve months (adjusted HR = 0.89, 95 %-CI: 0.66-1.18; p = 0.410), and 60.0 months [95 %-CI: 52.7-67.3] for patients with recurrent CRLM after twelve months (adjusted HR = 0.70, 95 %-CI: 0.53-0.92; p = 0.012). CONCLUSIONS Disease-free interval is considered a prognostic factor for overall survival, but should not be used as selection criterion per se for repeat hepatectomy in patients suffering from recurrent CRLM.
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Affiliation(s)
- Tessa Hellingman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands.
| | - Merijn E de Swart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Martijn W Heymans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Biostatistics, de Boelelaan 1089a, Amsterdam, the Netherlands
| | - Elise P Jansma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Biostatistics, de Boelelaan 1089a, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Information & Library, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Hans J van der Vliet
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands; LAVA Therapeutics, Yalelaan 60, Utrecht, the Netherlands
| | - Geert Kazemier
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
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Barrett JR, Abbott DE. Combined Proctectomy and Hepatectomy for Metastatic Rectal Cancer: Safe for the Fit and Able-But for Everyone? Ann Surg Oncol 2019; 26:3803-3804. [PMID: 31190208 DOI: 10.1245/s10434-019-07500-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Indexed: 11/18/2022]
Affiliation(s)
- James R Barrett
- Division of Surgical Oncology, Department of Surgery, Clinical Science Center, University of Wisconsin, Madison, WI, USA
| | - Daniel E Abbott
- Division of Surgical Oncology, Department of Surgery, Clinical Science Center, University of Wisconsin, Madison, WI, USA.
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Moreno Prats M, Sasatomi E, Stevenson HL. Colorectal Liver Metastases: A Pathologist's Guide to Creating an Informative Report and Improving Patient Care. Arch Pathol Lab Med 2018; 143:251-257. [PMID: 29790787 DOI: 10.5858/arpa.2017-0505-ra] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT.— In this era of minimally invasive procedures for diagnosis, prognosis, and treatment, pathologists are at the forefront of analyzing specimens and are expected to make more specific diagnoses, providing additional information from the material they receive. OBJECTIVE.— To familiarize pathologists with the essential components of surgical pathology reports for colorectal liver metastases (CRLM) resections. DATA SOURCES.— Colorectal cancer is the third most common cancer in the world and the liver is the most frequent site of metastases. Not all patients are candidates for surgery initially and may be treated with neoadjuvant chemotherapy, most commonly with FOLFOX (5-fluorouracil/leucovorin and oxaliplatin) and FOLFIRI (5-fluorouracil/leucovorin and irinotecan), after which they may become surgical candidates. When CRLM resections are received post neoadjuvant, the pathologist needs to not only report margin status but also report details regarding the tumor's response to treatment, and should evaluate the nonneoplastic parenchyma for chemotherapy-related injury, such as sinusoidal obstruction syndrome and/or steatohepatitis that may be caused by treatment. If ancillary tests, such as molecular studies (eg, KRAS, BRAF, NRAS, and microsatellite instability), have been previously conducted, these results should be included in the report. If not, they should be ordered for the resection specimen. CONCLUSIONS.— In this review, we will describe strategies and practical approaches to maximize the information gained from CRLM resections. A checklist is provided that may be used while signing out these cases to remind pathologists of additional components they may wish to include in their reports to best guide patient management.
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Affiliation(s)
- Mariana Moreno Prats
- From the Department of Pathology, University of Texas Medical Branch, Galveston (Drs Moreno Prats and Stevenson); and the Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill (Dr Sasatomi)
| | - Eizaburo Sasatomi
- From the Department of Pathology, University of Texas Medical Branch, Galveston (Drs Moreno Prats and Stevenson); and the Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill (Dr Sasatomi)
| | - Heather L Stevenson
- From the Department of Pathology, University of Texas Medical Branch, Galveston (Drs Moreno Prats and Stevenson); and the Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill (Dr Sasatomi)
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Stevenson HL, Prats MM, Sasatomi E. Chemotherapy-induced Sinusoidal Injury (CSI) score: a novel histologic assessment of chemotherapy-related hepatic sinusoidal injury in patients with colorectal liver metastasis. BMC Cancer 2017; 17:35. [PMID: 28061766 PMCID: PMC5219653 DOI: 10.1186/s12885-016-2998-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 12/13/2016] [Indexed: 12/20/2022] Open
Abstract
Background Preoperative neoadjuvant therapy for colorectal liver metastases (CRLM) is increasing in use and can lead to chemotherapy-induced damage to sinusoidal integrity, namely sinusoidal obstruction syndrome (SOS). SOS has been associated with an increased need for intraoperative blood transfusions, increased length of hospitalization post-surgery, decreased tumor response, and a shorter overall survival after resection due to liver insufficiency. It is critical for clinicians and pathologists to be aware of this type of liver injury, and for pathologists to include the status of the background, non-neoplastic liver parenchyma in their pathology reports. In this study, expression of CD34 by sinusoidal endothelial cells (SECs), increased expression of smooth muscle actin (SMA) by hepatic stellate cells (HSCs), and aberrant expression of glutamine synthetase (GS) by noncentrizonal hepatocytes were semiquantitatively evaluated in liver resection or biopsy specimens from patients with CRLM to determine their diagnostic value for assessing chemotherapy-induced sinusoidal injury (CSI). Methods The expression of each marker was compared among 22 patients with CRLM with histologically evident SOS (SOS+) and 8 patients with CRLM who had not undergone chemotherapy. Each case was given a histologic grade using the sinusoidal obstruction syndrome index score (SOS-I) to assess the likelihood of SOS. Cases were also given an immunohistochemical grade using the total CSI score calculated as the sum of CD34, SMA, and GS scores. Results Abnormal staining patterns for CD34 and SMA were significantly more frequent and extensive in SOS+ cases than in the controls (81.8% vs. 25%, P < 0.01; 72.7% vs. 25%, P = 0.03). Aberrant GS expression in midzonal and periportal hepatocytes was only observed in SOS+ cases (31.8% vs. 0%), but this difference did not reach statistical significance. The CSI score was significantly higher in the SOS+ cases when compared to controls (P < 0.01), and was associated with a higher SOS histologic grade (P = 0.02). Conclusions The CSI score, calculated using an immunohistochemical panel consisting of CD34, SMA, and GS, may serve as an objective marker of chemotherapy-induced sinusoidal injury and could help diagnose this peculiar form of liver injury.
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Affiliation(s)
- Heather L Stevenson
- Department of Pathology, The University of Texas Medical Branch, John Sealy Annex Building - Room 2.148, 301 University Blvd., Galveston, TX, 77555-0588, USA
| | - Mariana M Prats
- Department of Pathology, The University of Texas Medical Branch, John Sealy Annex Building, 301 University Blvd., Galveston, TX, 77555-0588, USA
| | - Eizaburo Sasatomi
- Department of Pathology, The University of Texas Medical Branch, John Sealy Annex Building - Room 2.148, 301 University Blvd., Galveston, TX, 77555-0588, USA. .,Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill Women's & Children's Hospitals, Room 30212, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
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Matouk IJ, Halle D, Raveh E, Gilon M, Sorin V, Hochberg A. The role of the oncofetal H19 lncRNA in tumor metastasis: orchestrating the EMT-MET decision. Oncotarget 2016; 7:3748-65. [PMID: 26623562 PMCID: PMC4826167 DOI: 10.18632/oncotarget.6387] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/15/2015] [Indexed: 12/14/2022] Open
Abstract
Long non-coding RNA (lncRNA) genes are emerging as key players in the metastatic cascade. Current evidence indicate that H19 lncRNA and the microRNA(miRNA) miR-675, which is processed from it, play crucial roles in metastasis, through the regulation of critical events specifically the epithelial to mesenchymal (EMT) and the mesenchymal to epithelial transitions (MET). This review summarizes recent mechanistic pathways and tries to put together seemingly conflicting data from different reports under one proposed general scheme underlying the various roles of H19/miR-675 in the metastatic cascade. We propose several approaches to harnessing this knowledge for translational medicine.
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Affiliation(s)
- Imad J. Matouk
- Department of Biological Chemistry, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Biological Sciences, Faculty of Science and Technology, Al-Quds University, Jerusalem, West Bank
| | - David Halle
- Department of Biological Chemistry, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eli Raveh
- Department of Biological Chemistry, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Gilon
- Department of Biological Chemistry, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Vladimir Sorin
- Department of Biological Chemistry, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avraham Hochberg
- Department of Biological Chemistry, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
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Hassanain M, Al-alem F, Simoneau E, Traiki TA, Alsaif F, Alsharabi A, Al-Faris H, Al-saleh K. Colorectal cancer liver metastasis trends in the kingdom of Saudi Arabia. Saudi J Gastroenterol 2016; 22:370-374. [PMID: 27748323 PMCID: PMC5051221 DOI: 10.4103/1319-3767.191142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIM To elucidate colorectal cancer (CRC) disease patterns, demographics, characteristics, stage at presentation, metastases, and survival rates of patients, particularly those with liver metastases, at our center as the first report from the Kingdom of Saudi Arabia. PATIENTS AND METHODS We performed a retrospective, single-center database study based on the histological diagnosis of CRC in patients seen at the King Khalid University Hospital between 2007 and 2011. RESULTS 427 cases of CRC with a mean age at diagnosis of 55.47 12.85 years, out of which 96% were resected. Stage II was predominant at presentation, followed by both stage III and IV, with the remainder being stage I. One hundred patients had distant metastases, of which the liver was the only location in 54 patients. Mean survival was 3.0 years. Overall survival rates for CRC patients with liver metastases who underwent resection were 30% at 2 years and 17% at 5 years, and the mean survival rate was 1.4 years. CONCLUSIONS Both the mean survival rate of our CRC patients with resectable liver metastases and the 5-year survival rate of these patients are lower than global averages. This discrepancy is likely due to late diagnoses rather than more aggressive disease.
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Affiliation(s)
- Mazen Hassanain
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Oncology, McGill University, Montreal, Quebec, Canada,Address for correspondence: Dr. Mazen Hassanain, Department of Surgery, College of Medicine, King Saud University, Riyadh - 11472, Kingdom of Saudi Arabia. E-mail:
| | - Faisal Al-alem
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Eve Simoneau
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Thamer A. Traiki
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faisal Alsaif
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulsalam Alsharabi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Heba Al-Faris
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Al-saleh
- Division of Medical Oncology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Rodríguez-Fraile M, Iñarrairaegui M. Radioembolization with 90Y-microspheres for liver tumors. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.05.001] [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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Rodríguez-Fraile M, Iñarrairaegui M. [Radioembolization with (90)Y-microspheres for liver tumors]. Rev Esp Med Nucl Imagen Mol 2015; 34:244-57. [PMID: 25911062 DOI: 10.1016/j.remn.2015.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 12/16/2022]
Affiliation(s)
- M Rodríguez-Fraile
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Navarra; Área de Oncología Hepatobiliopancreática, Clínica Universidad de Navarra, Pamplona, Navarra, España; Instituto de Investigaciones Sanitarias de Navarra (IDISNA), España.
| | - M Iñarrairaegui
- Unidad de Hepatología, Clínica Universidad de Navarra, Pamplona, Navarra, España; Área de Oncología Hepatobiliopancreática, Clínica Universidad de Navarra, Pamplona, Navarra, España; Instituto de Investigaciones Sanitarias de Navarra (IDISNA), España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Pamplona, España
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Vogl TJ, Kreutzträger M, Gruber-Rouh T, Eichler K, Nour-Eldin NEA, Zangos S, Naguib NNN. Neoadjuvant TACE before laser induced thermotherapy (LITT) in the treatment of non-colorectal non-breast cancer liver metastases: feasibility and survival rates. Eur J Radiol 2014; 83:1804-10. [PMID: 25082479 DOI: 10.1016/j.ejrad.2014.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 06/05/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate safety, feasibility and overall survival rates for transarterial chemoembolization (TACE) alone or combined with MR-guided laser-induced-thermotherapy (LITT) in liver metastases of non-colorectal and non-breast cancer origin. METHODS AND MATERIALS Included were patients with unresectable non-colorectal non-breast cancer liver metastases with progression under systemic chemotherapy. Excluded were patients with Karnofsky score ≤ 70, respiratory, renal and cardiovascular failure, and general TACE contraindications. TACE using Mitomycin alone, Mitomycin-Gemcitabine or Mitomycin-Gemcitabine-Cisplatin was performed to all patients. After TACE 146 metastases were ablated with MR-guided LITT. To be eligible for LITT metastases should be < 5 cm in size and ≤ 5 in number. Tumor response was evaluated using MRI according to RECIST. Survival was evaluated using Kaplan-Meier analysis. RESULTS A total of 110 patients (mean age 59.2 years) with 371 metastases received TACE (mean 5.4 sessions/patient, n=110) with 76 (69%) receiving LITT (mean 1.6 session/patient) afterwards. TACE resulted in a mean decrease of mean maximum diameter of 52% ± 26.6 and volume change of -68.5% ± 22.9 in the 25 patients (23%) with partial response. Stable disease (n=59, 54%). Progressive disease (n=26, 23%). The RECIST outcome after LITT showed complete response (n=13, 17%), partial response (n=1, 1%), stable situation (n=41, 54%) and progressive disease (n=21, 28%). The mean time to progression (TTP) was 8.6 months. Median survival of all patients was 21.1 months. CONCLUSION TACE with different protocols alone and in combination with LITT is a feasible palliative treatment option resulting in a median survival of 21.1 months for unresectable liver metastases of non-colorectal and non-breast cancer origin.
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Affiliation(s)
- Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Germany.
| | - Martin Kreutzträger
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Germany
| | - Katrin Eichler
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Germany
| | - Nour-Eldin A Nour-Eldin
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Germany; Department of Diagnostic and Interventional Radiology, Cairo University, Cairo, Egypt
| | - Stephan Zangos
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Germany
| | - Nagy N N Naguib
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Germany; Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Montalti R, Berardi G, Laurent S, Sebastiani S, Ferdinande L, Libbrecht LJ, Smeets P, Brescia A, Rogiers X, de Hemptinne B, Geboes K, Troisi RI. Laparoscopic liver resection compared to open approach in patients with colorectal liver metastases improves further resectability: Oncological outcomes of a case-control matched-pairs analysis. Eur J Surg Oncol 2014; 40:536-544. [PMID: 24555996 DOI: 10.1016/j.ejso.2014.01.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/23/2013] [Accepted: 01/05/2014] [Indexed: 02/07/2023] Open
Abstract
AIMS Liver resection is considered the standard treatment of colorectal metastases (CRLM). However, to date, no long term oncological results and data regarding repeat hepatectomy after laparoscopic approach are known. The aim of this study is to analyze single center long-term surgical and oncological outcomes after liver resection for CRLM. METHODS A total of 57 open resections (OR) were matched with 57 laparoscopic resections (LR) for CRLM. Matching was based mainly on number of metastases, tumor size, segmental position of lesions, type of hepatectomy and type of resection. RESULTS Morbidity rate was significantly less in the LR group (p = 0.002); the length of hospital stay was 6.5 ± 5 days for the LR group and 9.2 ± 4 days for the OR group (p = 0.005). After a median follow up of 53.7 months for the OR group and 40.9 months for the LR group, the 5-y overall survival rate was 65% and 60% respectively (p = 0.36) and the 5-y disease free survival rate was 38% and 29% respectively (p = 0.24). More patients in the LR group received a third hepatectomy for CRLM relapse than in the OR group (80% vs. 14.3% respectively; p = 0.015). CONCLUSIONS Laparoscopic resection for CRLM offers advantages in terms of reduced blood loss, morbidity rate and hospital stay. It provides comparable long-term oncological outcomes but can improve further resectability in patients with recurrent disease.
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Affiliation(s)
- R Montalti
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium
| | - G Berardi
- Dept. of General Surgery, Sant'Andrea Hospital, "La Sapienza" University of Rome, Italy
| | - S Laurent
- Dept. of Gastroenterology-Abdominal Oncology Unit, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - S Sebastiani
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium
| | - L Ferdinande
- Dept. of Pathology, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - L J Libbrecht
- Dept. of Pathology, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - P Smeets
- Dept. of Radiology, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - A Brescia
- Dept. of General Surgery, Sant'Andrea Hospital, "La Sapienza" University of Rome, Italy
| | - X Rogiers
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium
| | - B de Hemptinne
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium
| | - K Geboes
- Dept. of Gastroenterology-Abdominal Oncology Unit, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - R I Troisi
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium.
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Watanabe K, Saito N, Sugito M, Ito M, Kobayashi A, Nishizawa Y. Incidence and predictive factors for pulmonary metastases after curative resection of colon cancer. Ann Surg Oncol 2012. [PMID: 23196787 DOI: 10.1245/s10434-012-2747-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess the actuarial incidence of pulmonary metastases as the first site of metastasis after R0 resection of colon cancer and to clarify predictive factors for pulmonary metastases as the first site of metastasis. METHODS Data for 746 patients who underwent R0 resection for colon cancer from 2000 to 2006 were reviewed. The mean duration of follow-up was 56.9 months. RESULTS Pulmonary metastases developed in 35 patients. Mean duration from colon surgery to identification of pulmonary metastases was 20.0 months. The overall occurrence rates of 5-year pulmonary metastasis according to Union for International Cancer Control (UICC) stage were 0.6 % (stage I), 2.2 % (stage II), 9.8 % (stage III), and 24.6 % (stage IV), respectively. Surgery for pulmonary metastases was performed first 18 patients (51.4 %), and 16 (88.9 %) of these 18 patients achieved R0 surgery. Multivariate analysis revealed that presence of regional lymph node involvement and preoperative serum carcinoembryonic antigen level (≥5 ng/ml) were significant independent risk factors for pulmonary metastases. Five-year actuarial incidence of pulmonary metastases increased significantly with increased number of risk factors (0 factors, 2.2 %; 1 factor, 6.6 %; 2 factors, 18.4 %). CONCLUSIONS The present study clearly demonstrated predictive factors for pulmonary metastases after R0 resection of colon cancer. Actuarial incidence of pulmonary metastases was significantly related to the number of risk factors present. The data should facilitate the establishment of novel algorithms for predicting pulmonary metastases after resection of colon cancer, which may lead to the appropriate surveillance strategies after colon surgery.
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Affiliation(s)
- Kazuhiro Watanabe
- Department of Surgical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
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Repeated Liver Resection for Colorectal Liver Metastases: A Comparison with Primary Liver Resections concerning Perioperative and Long-Term Outcome. Gastroenterol Res Pract 2012; 2012:568214. [PMID: 22973305 PMCID: PMC3437631 DOI: 10.1155/2012/568214] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 06/07/2012] [Indexed: 12/29/2022] Open
Abstract
Introduction. 60% of patients operated for colorectal liver metastases (CRLM) will develop recurrent disease and some may be candidates for a repeated liver resection. The study aimed to evaluate differences in intraoperative blood loss and complications comparing the primary and the repeated liver resection for metastases of colorectal cancer (CRC), as well as to evaluate differences in long-time follow-up. Method. 32 patients underwent 34 repeated liver resections due to recurrence of CRLM an studied retrospectively to identify potential differences between the primary and the repeat resections. Results. There was no 30-day postoperative mortality or postoperative hospital deaths. The median blood loss at repeat resection (1850 mL) was significantly (P = 0.014) higher as compared to the primary liver resection (1000 mL). This did not have any effect on the rate of complications, even though increased bleeding in itself was a risk factor for complications. There were no differences in survival at long-term follow-up. Discussion. A repeated liver resection for CRLM was associated with an increased intraoperative bleeding as compared to the first resection. Possible explanations include presence of adhesions, deranged vascular anatomy, more complicated operations and the effects on the liver by chemotherapy following the first liver resection. 30 out of 32 patients had only one reresection of the liver.
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Abstract
BACKGROUND Resection of liver metastases is accepted as treatment for diverse tumours, implying a survival improvement. Metastases often recur after first hepatectomy and, very few would be potentially resectable. MATERIALS AND METHODS A retrospective study of 18 patients undergoing repeated hepatectomies (two or more liver resections in the same patient) due to metastases of colorectal cancer between 1988 and 2006 was performed. RESULTS Thirteen men and five women, mean age 57.55 years, participated. In all patients, repeated liver resection was performed due to recurrence of the metastases. Complications rate after first hepatectomy was 11.1% and after the second 16.6%. Mortality rate was 11.1% after second hepatectomy, and there was no mortality after third hepatectomy. Three- and 5-year survival after colectomy was 88.9% and 77.8%, respectively; after first hepatectomy 3- and 5-year survival was 88.9% and 61.1%, respectively; after second hepatectomy, 3- and 5-year survival was 83.3% and 61.1% respectively; and 3-year survival after third hepatectomy was 67%. CONCLUSION Repeated resections by expert surgeons for recurrent liver metastases can be safely performed, with low morbidity and mortality rates similar to first hepatectomies. Repeated resections of liver metastases of colorectal cancer improve global survival.
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Ypsilantis P, Panopoulou M, Lambropoulou M, Tsigalou C, Pitiakoudis M, Tentes I, Kartali S, Papachristou F, Papadopoulos N, Simopoulos C. Bacterial Translocation in a Rat Model of Large Volume Hepatic Radiofrequency Ablation. J Surg Res 2010; 161:250-8. [DOI: 10.1016/j.jss.2009.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Revised: 01/12/2009] [Accepted: 01/16/2009] [Indexed: 01/16/2023]
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16
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Smith MD, McCall JL. Systematic review of tumour number and outcome after radical treatment of colorectal liver metastases. Br J Surg 2009; 96:1101-13. [DOI: 10.1002/bjs.6735] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Background
Resection of colorectal liver metastases (CLMs) is potentially curative but the effect of tumour number on prognosis is uncertain. This study compared the prognosis after resection and/or ablation of between one and three, or four or more CLMs.
Methods
A systematic literature review from January 2000 to June 2008 was performed. Study selection and data extraction were standardized, and analysis included assessment of methodological quality, heterogeneity and bias. Main outcomes were 3- and 5-year survival. A meta-analysis comparing radical treatment in the two groups was performed using the hazard ratio for overall survival.
Results
Of 1307 studies screened, 46 (9934 patients) were included in the analysis. Methodological quality was variable, and there was significant heterogeneity and reporting bias. The overall 5-year survival rate after radical treatment ranged from 7 to 58 per cent. Pooled hazard ratio for overall survival was 1·67 (95 per cent confidence interval 1·43 to 1·95; P < 0·001). Median reported 5-year survival for patients with four or more CLMs was 17·1 per cent.
Conclusion
Radical treatment of more than three CLMs results in poorer overall survival. Nevertheless, 5-year survival is achievable and the number of lesions should not, of itself, be used to exclude patients from surgery.
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Affiliation(s)
- M D Smith
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - J L McCall
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
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Cianni R, Urigo C, Notarianni E, Saltarelli A, Salvatori R, Pasqualini V, Dornbusch T, Cortesi E. Selective internal radiation therapy with SIR-spheres for the treatment of unresectable colorectal hepatic metastases. Cardiovasc Intervent Radiol 2009; 32:1179-86. [PMID: 19680720 DOI: 10.1007/s00270-009-9658-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 05/22/2009] [Accepted: 06/22/2009] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to evaluate the effectiveness of colorectal cancer (CRC) liver metastasis radioembolization with yttrium-90 (Y90), assessing toxicity and survival rates in patients with no response to chemotherapy through our 3-year experience. From February 2005 to January 2008, we treated 41 patients affected by CRC from a cohort of selective internal radiation therapy patients treated at our institution. All patients examined showed disease progression and arrived for our observation with an abdominal CT, a body PET, and a hepatic angiography followed by gastroduodenal artery coiling previously performed by us. We excluded patients with a bilirubin level>1.8 mg/dl and pulmonary shunt>20% but not patients with minor extrahepatic metastases. On treatment day, under fluoroscopic guidance, we implanted a dose of Y90 microspheres calculated on the basis of liver tumoral involvement and the body surface area formula. All patients were discharged the day after treatment. We obtained, according to Response Evaluation Criteria on Solid Tumors, a complete response in 2 patients, a partial response in 17 patients, stable disease in 14 patients, and progressive disease in 8 patients. In all cases, we obtained a carcinoembryonic antigen level decrease, especially in the week 8 evaluation. Technical success rate was 98% and technical effectiveness estimated at 3 months after treatment was 80.5%. Side effects graded by Common Terminology Criteria on Adverse Events were represented by one grade 4 hepatic failure, two grade 2 gastritis, and one grade 2 cholecystitis. The median survival and the progression-free survival calculated by Kaplan-Meier analysis were 354 and 279 days, respectively. In conclusion, according to our 3-year experience, Y90 SIR-Spheres radioembolization is a feasible and safe method to treat CRC liver metastases, with an acceptable level of complications and a good response rate.
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Affiliation(s)
- Roberto Cianni
- Diagnostic and Interventional Radiology Department, S. M. Goretti General Hospital, Via G. Reni, 04100, Latina, Italy
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Pacella CM, Valle D, Bizzarri G, Pacella S, Brunetti M, Maritati R, Osborn J, Stasi R. Percutaneous laser ablation in patients with isolated unresectable liver metastases from colorectal cancer: Results of a phase II study. Acta Oncol 2009; 45:77-83. [PMID: 16464799 DOI: 10.1080/02841860500438029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We prospectively evaluated the safety, local tumor control, and impact on survival parameters of percutaneous laser ablation (PLA) in patients with colorectal liver metastases not amenable to surgical resection. The study included 44 individuals with 75 unresectable liver metastases and no known extrahepatic disease. The median number of metastases treated for each patient was one, with a range of 1-4. Metastases had a median diameter of 3.4 cm (range 0.5-9 cm), and a median volume of 16.8 cm(3) (range 0.4-176.4 cm(3)). All patients also received systemic chemotherapy with modalities that differed according to the type of response to PLA. After treatment, 61% (46/75) of the tumors were ablated completely. The likelihood of achieving a complete ablation was significantly higher when metastases had a diameter <3.0 cm (p = 0.004). Overall survival was 30.0+/-12.7 months in patients with a complete ablation, and 20.2+/-10.2 months in those with a partial ablation (p = 0.002). There were no major complications during or after PLA, the most frequent side effect being abdominal pain that required analgesics. These findings indicate that PLA can be safely used as an adjunct to chemotherapy in unresectable colorectal liver metastases, and may have a positive impact on survival.
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Affiliation(s)
- Claudio M Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Italy.
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Weber T, Link KH. Radikale Chirurgie bei primär metastasierten kolorektalen Karzinomen. Visc Med 2007. [DOI: 10.1159/000110482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier AM. Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 2006; 244:254-9. [PMID: 16858188 PMCID: PMC1602156 DOI: 10.1097/01.sla.0000217629.94941.cf] [Citation(s) in RCA: 932] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE/BACKGROUND Little is known about the epidemiology and the management of liver metastases from colorectal cancer at a population level. The aim of this population-based study was to report on the incidence, treatment, and prognosis of synchronous and metachronous liver metastases. METHODS Data were obtained from the population-based cancer registry of Burgundy (France). RESULTS The proportion of patients with synchronous liver metastases was 14.5%. Age-standardized incidence rates were 7.6 per 100,000 in males, 3.7 per 100,000 in females. The 5-year cumulative metachronous liver metastasis rate was 14.5%. It was 3.7% for TNM stage I tumors, 13.3% for stage II, and 30.4% for stage III (P < 0.001). The risk of liver metastasis was also associated to gross features. Resection for cure was performed in 6.3% of synchronous liver metastases and 16.9% of metachronous liver metastases. Age, presence of another site of recurrence, and period of diagnosis were independent factors associated with the performance of a resection for cure. The 1- and 5-year survival rates were 34.8% and 3.3% for synchronous liver metastases. Their corresponding rates were, respectively, 37.6% and 6.1% for metachronous liver metastases. CONCLUSION Liver metastases from colorectal cancer remain a substantial problem. More effective treatments and mass screening represent promising approaches to decrease this problem.
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Affiliation(s)
- Sylvain Manfredi
- Registre Bourguignon des Cancers Digestifs, Faculté de Médecine, Dijon Cedex, France
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Kollmar O, Richter S, Schilling MK, Menger MD, Pistorius GA. Advanced hepatic tissue destruction in ablative cryosurgery: potentials of intermittent freezing and selective vascular inflow occlusion. Cryobiology 2004; 48:263-72. [PMID: 15157775 DOI: 10.1016/j.cryobiol.2004.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2003] [Accepted: 02/04/2004] [Indexed: 11/17/2022]
Abstract
Recent studies indicate that cryosurgery represents a promising approach to treat non-resectable liver tumors. To improve parenchymal tissue destruction, a variety of modifications of the freeze-thaw procedure have been suggested, including repetitive freezing and portal-triad cross-clamping. The aim of the present study was to analyze whether intermittent freezing by application of a double freeze-thaw procedure or selective vascular inflow occlusion are more effective than a single freeze-thaw cycle to achieve complete hepatic tissue destruction. Using a porcine model, intrahepatic cryolesions were induced by freezing the hepatic tissue for a total of 15 min (n=6, SF). Additional animals (n=6) underwent a double freeze-thaw cycle of 7.5 min each (DF). A third group of animals (n=6) was treated by a single 15-min freeze-thaw cycle during selective vascular inflow occlusion (VO-SF). Seven days after freezing, DF did not change the volume of the cryolesion (25.4+/-1.7 cm(3)) compared to SF (29.9+/-3.7 cm(3)), however, resulted in enhanced destruction of hepatocyte nuclear morphology (DF-score: 2.4+/-0.2 versus SF-score: 1.1+/-0.3; p<0.05) and attenuated leukocyte infiltration within the margin of the cryolesion (DF-score: 1.5+/-0.2 versus SF-score: 2.8+/-0.1; p<0.05). VO-SF was also effective to significantly enhance destruction of hepatocyte nuclear morphology (2.8+/-0.1; p<0.05 versus SF), but, additionally, markedly increased the volume of the cryolesions (43.3+/-5.3 cm(3); p<0.05 versus SF and DF). Interestingly, VO-SF further increased the number of apoptotic cells, while leukocyte infiltration (2.3+/-0.3) was not affected compared to that after SF-treatment. Thus, our data indicate that both DF and VO-SF are effective to enhance parenchymal cell destruction within the margin of the cryolesion. VO-SF additionally increases the volume of the lesion and may therefore be most attractive for successful clinical application.
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Affiliation(s)
- Otto Kollmar
- Department of General, Visceral and Vascular Surgery, D-66421 Homburg/Saar, Germany.
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Barber FD, Fabugais-Nazario LE. What's old is new again: patients receiving hepatic arterial infusion chemotherapy. Clin J Oncol Nurs 2004; 7:647-52. [PMID: 14705480 DOI: 10.1188/03.cjon.647-652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hepatocellular carcinoma (HCC) ranks as the eighth most common cancer in the world. Although uncommon in North America, the incidence of HCC in the United States has increased by 70% since the 1980s (Yu, Yuan, Govindarajan, & Ross, 2000). The most frequent causes of malignant hepatic disease in the United States are metastases from melanoma and primary tumors of the gastrointestinal tract, breast, and lung. Surgical resection and systemic chemotherapy are the standard treatments for this disease. However, surgery is not an option for patients with advanced disease, and the response rate from systemic chemotherapy remains low. An alternative therapy for patients with HCC or cancers with liver metastases is hepatic arterial infusion of chemotherapy directly into the liver. This method allows a high total body clearance and hepatic extraction to generate high hepatic and low systemic exposures. Nursing care of patients receiving hepatic arterial infusion of chemotherapy includes patient education and monitoring for complications.
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