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Khan D, Khan AK, Khan SD, Aman M, Amin A, Waseem M, Kumari U, Khan F, Pervez A, Khan A. The tendency of segmental distribution of hepatic metastasis according to couinaud classification: a comparison of portal versus systemic route of metastatis due to primary colorectal and breast tumors. Ann Med Surg (Lond) 2023; 85:4806-4810. [PMID: 37811027 PMCID: PMC10552961 DOI: 10.1097/ms9.0000000000001241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/16/2023] [Indexed: 10/10/2023] Open
Abstract
Objective The liver is the commonest site of metastatic disease for patients with colorectal cancer (CRC), with at least 25% of patients developing liver metastasis (LM) during their illness. About 50% of patients diagnosed with metastatic breast cancer develop LM, and 5-12% of these patients develop LM as the main site of breast cancer recurrence. This study aims to determine the frequency of segmental distribution of LM seeding from portal versus systemic routes of dissemination due to primary CRC and breast carcinoma, respectively. Material and methods This retrospective study was conducted in a tertiary care teaching hospital in Pakistan. Ethical approval was taken from the institutional review board. A total of 587 patients were included in the study with 297 CRC patients with LM and 300 breast carcinoma patients with LM. Segment I involvement was excluded from the calculation because of the dual blood supply. Patients' detailed demographics and other information were collected on a predesigned proforma. The authors evaluated axial and multiplanar reformatted computed tomography images for LM and CRC metastasis. Data analysis was done using SPSS version 25. P value less than or equal to 0.05 was considered statistically significant. Results A study population of 587 patients was employed that comprised 287 CRC and 300 breast carcinoma patients. There were 179 (30.5%) male and 408 (69.5%) female patients. The mean age of patients was 54.9±13.3. The study revealed that 204 (34.8%) CRC patients showed right lobe (V, VI, VII, VIII) and 83 (14.1%) CRC patients showed left lobe involvement of metastasis while 192 (32.7%) breast carcinoma patients showed right lobe involvement and 108 (18.4%) breast carcinoma patients showed left lobe involvement in metastasis (P=0.02). We also found 40 (6.8%) colorectal and 55 (9.4%) breast carcinoma patients showed left lateral segment (II, III) involvement. Medial segment involvement (IV) was seen in 43 (7.3%) CRC patients and 53 (9%) breast carcinoma patients (P=0.03). Conclusion The right hepatic lobe is the predominant site of metastasis independent of the portal or systemic route of dissemination in primary carcinoma. Moreover, in left lobe metastasis medial segment (IV) is more affected in CRC while the lateral segment (II, III) is more affected in breast carcinoma.
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Affiliation(s)
| | | | | | | | | | - Maria Waseem
- Dow University of Health Sciences, Karachi, Pakistan
| | - Usha Kumari
- Dow University of Health Sciences, Karachi, Pakistan
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Treska V, Skala M, Prochazkova K, Svejdova A, Petrakova T, Sebek J, Riha I, Rosendorf J, Polak R, Skalicky T, Liska V. Long-term Results of Surgery for Colorectal Liver Metastases in Terms of Primary Tumour Location and Clinical Risk Factors. In Vivo 2021; 34:2675-2685. [PMID: 32871799 DOI: 10.21873/invivo.12087] [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: 04/11/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM The aim of the study was to evaluate the influence of primary tumour location and clinical risk factors for long-term results of surgery for colorectal liver metastases (CLMs). PATIENTS AND METHODS Overall survival (OS) and recurrence-free survival (RFS) were evaluated in 636 patients. Patients were divided by tumour location (right-/left-sided colorectal cancer: RCRC/LCRC; rectal cancer), and age, gender, number and size of CLMs, type of liver surgery and interval from primary operation were evaluated. RESULTS One-, 3- and 5-year OS and RFS were independent of primary tumour location (p<0.59). CLM diameter was negatively associated with OS for the whole cohort (p<0.002), and RCRC (p<0.03) and LCRC (p<0.04) groups, as well as for RFS of those with LCRC (p<0.04). CLM number was negatively associated with RFS for the whole cohort (p<0.0001), RCRC (p<0.02), LCRC (p<0.0001) and RC (p<0.02). Radiofrequency ablation and combined procedures led to worse OS for the whole cohort (p<0.03), and to worse RFS for the whole cohort (p<0.0003) and for those with LCRC (p<0.03). A shorter interval between primary colorectal cancer surgery and CLMs procedure was risky for poor OS and RFS of patients with CLMs from RCRC (p<0.05), LCRC (p<0.05) and RC (p<0.02). CONCLUSION Primary tumour location together with clinical risk factors are important for long-term results of surgery CLMs.
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Affiliation(s)
- Vladislav Treska
- Department of Surgery, University Hospital, School of Medicine in Pilsen, Pilsen, Czech Republic
| | - Martin Skala
- Department of Surgery, University Hospital, School of Medicine in Pilsen, Pilsen, Czech Republic
| | - Kristyna Prochazkova
- Department of Surgery, University Hospital, School of Medicine in Pilsen, Pilsen, Czech Republic
| | - Aneta Svejdova
- Department of Surgery, University Hospital, School of Medicine in Pilsen, Pilsen, Czech Republic
| | - Tereza Petrakova
- Department of Surgery, University Hospital, School of Medicine in Pilsen, Pilsen, Czech Republic
| | - Jakub Sebek
- Department of Surgery, University Hospital, School of Medicine in Pilsen, Pilsen, Czech Republic
| | - Ivan Riha
- Department of Surgery, University Hospital, School of Medicine in Pilsen, Pilsen, Czech Republic
| | - Jachym Rosendorf
- Department of Surgery, University Hospital, School of Medicine in Pilsen, Pilsen, Czech Republic
| | - Robert Polak
- Department of Surgery, University Hospital, School of Medicine in Pilsen, Pilsen, Czech Republic
| | - Tomas Skalicky
- Department of Surgery, University Hospital, School of Medicine in Pilsen, Pilsen, Czech Republic
| | - Vaclav Liska
- Department of Surgery, University Hospital, School of Medicine in Pilsen, Pilsen, Czech Republic
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Marchese U, Seux H, Garnier J, Ewald J, Piana G, Lelong B, Chaisemartin CD, Meillat H, Delpero JR, Turrini O. Is percutaneous destruction of a solitary liver colorectal metastasis as effective as a resection? Ann Hepatobiliary Pancreat Surg 2021; 25:198-205. [PMID: 34053922 PMCID: PMC8180403 DOI: 10.14701/ahbps.2021.25.2.198] [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: 07/09/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022] Open
Abstract
Backgrounds/Aims Surgical resection remains the gold standard in the treatment of colorectal liver metastasis. However, when a patient presents with a deep solitary colorectal liver metastasis (S-CLM), the balance between the hepatic volume sacrificed and the S-CLM volume is sometimes clearly unappropriated. Thus, alternatives to surgery, such as operative and percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA), have been developed. This study aimed to identify the prognostic factors affecting survival of patients with S-CLM who undergo curative-intent liver resection or local destruction (RFA or MWA). Methods We retrospectively identified 211 patients with synchronous or metachronous S-CLM who underwent either surgical resection (n=182) or local destruction (RFA or MWA; n=29) according to the S-CLM size, location, and surrounding Glissonian structures. Results Patients who underwent RFA or MWA had S-CLM of a smaller size than those who underwent resection (mean 19.7 vs. 37.3 mm, p<.01). The 1-, 3-, and 5-year overall survival (OS) rates were 97.4%, 84.9%, and 74.9%, respectively. The 1-, 3-, and 5-year disease-free survival (DFS) rates were 77.9%, 47%, and 38.9%, respectively. S-CLM located in the left liver (p=.04), S-CLM KRAS mutation (p<.01), and extra-hepatic recurrence (p<.01) were identified as independent poor risk factors for overall survival (OS); the OS and DFS were comparable in patients with surgical procedure or percutaneous MWA. Conclusions In eligible S-CLM cases, percutaneous MWA seems to be as oncologically efficient as surgical resection and should be include in the decision-tree for treatment strategies.
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Affiliation(s)
- Ugo Marchese
- Department of Surgery, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, Inserm, CRCM, Marseille, France
| | - Héloïse Seux
- Department of Surgery, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, Inserm, CRCM, Marseille, France
| | - Jonathan Garnier
- Department of Surgery, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, Inserm, CRCM, Marseille, France
| | - Jacques Ewald
- Department of Surgery, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, Inserm, CRCM, Marseille, France
| | - Gilles Piana
- Department of Radiology, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, Inserm, CRCM, Marseille, France
| | - Bernard Lelong
- Department of Surgery, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, Inserm, CRCM, Marseille, France
| | - Cécile De Chaisemartin
- Department of Surgery, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, Inserm, CRCM, Marseille, France
| | - Hélène Meillat
- Department of Surgery, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, Inserm, CRCM, Marseille, France
| | - Jean-Robert Delpero
- Department of Surgery, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, Inserm, CRCM, Marseille, France
| | - Olivier Turrini
- Department of Surgery, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, Inserm, CRCM, Marseille, France
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de Araujo EM, Torres US, Racy DJ, Torres LR, Chojniak R, D’Ippolito G. The "streamline phenomenon" of the portal vein flow and its influence on liver involvement by gastrointestinal diseases: current concepts and imaging-based review. Abdom Radiol (NY) 2020; 45:403-415. [PMID: 31768597 DOI: 10.1007/s00261-019-02335-2] [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: 10/25/2022]
Abstract
The streamline flow in the portal system is a phenomenon by which blood from superior mesenteric vein goes preferentially to the right hepatic lobe, while splenic and inferior mesenteric veins divert preferentially to the left lobe. Such a phenomenon results in different patterns of distribution of several liver diseases. The purpose of this article is to discuss the concepts behind the theory of streamline flow and to perform an imaging-based review of representative cases, demonstrating how it may influence the patterns of liver involvement in different gastrointestinal diseases.
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Zhou F, Yu X, Liang P, Han Z, Cheng Z, Yu J, Liu F, Hu Y. Does primary tumor location impact the prognosis of colorectal liver metastases patients after microwave ablation? - Lessons from 10 years' experience. Oncotarget 2017; 8:100791-100800. [PMID: 29246023 PMCID: PMC5725065 DOI: 10.18632/oncotarget.18764] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/09/2017] [Indexed: 12/26/2022] Open
Abstract
Thermal ablation has been considered as an alternative for local curative intent in patients with unresectable colorectal liver metastases. The influence of primary tumor location on the prognosis of colorectal liver metastases patients who have undergone microwave ablation has yet to be determined. We reviewed 295 patients who underwent microwave ablation for colorectal liver metastases at our institution between March 2006 and March 2016. Univariate and multivariate analyses were performed to identify predictors of overall and progression-free survival. Technical success was achieved in 96.6% of patients (n = 289), with a post-procedural complication rate of 2.0% (n = 6). After a median follow-up of 24 (range, 2–86) months, comparable overall survival rates (p = 0.583) were observed in patients with different primary tumor locations. Patients with colorectal liver metastases originating from left-sided primary colon cancer exhibited a better progression-free survival than patients whose colorectal liver metastases had originated from right-sided primary colon cancer (hazard ratio: 0.67, 95.0% confidence interval: 0.48–0.94; p = 0.012), which was further confirmed in a multivariate analysis after adjustment for other potential prognostic factors. Stratification based on primary tumor location should be taken into consideration in the assessment of disease progression in patients who intend to undergo microwave ablation for colorectal liver metastases.
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Affiliation(s)
- Fubo Zhou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Yi Hu
- Department of Oncology, Chinese PLA General Hospital, Beijing 100853, China
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