1
|
Bonde A, Fung AW, Mayo SC, Li P, Walker BS, Jaganathan S, Mallak N, Korngold EK. Imaging of the hepatic arterial infusion pump: Primer for radiologists. Clin Imaging 2024; 105:110022. [PMID: 37992624 DOI: 10.1016/j.clinimag.2023.110022] [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: 05/31/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023]
Abstract
Hepatic arterial infusion (HAI) pumps are used to deliver liver-directed therapy by allowing the administration of selective chemotherapy to the liver via a catheter implanted most commonly into the gastroduodenal artery connected to a subcutaneous pump. This selective administration helps maximize the chemotherapeutic effect within the hepatic tumors while minimizing systemic toxicity. While HAI therapy has primarily been used to treat liver-only metastatic colorectal cancer, the indications have expanded to other malignancies, including intrahepatic cholangiocarcinoma. Radiologists play an important role in pre-operative planning, assessment of treatment response, and evaluation for potential complications using various imaging studies, including computed tomography angiography, magnetic resonance imaging, and perfusion scintigraphy. This article describes the radiologist's role as part of a multi-disciplinary oncology team to help maximize the success of HAI therapy and also helps radiologists familiarize themselves with various aspects of HAI pumps.
Collapse
Affiliation(s)
- Apurva Bonde
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States of America.
| | - Alice W Fung
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Skye C Mayo
- Department of Surgical Oncology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Peter Li
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Brett S Walker
- Department of Surgical Oncology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Sriram Jaganathan
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, AR 72205, United States of America
| | - Nadine Mallak
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Elena K Korngold
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| |
Collapse
|
2
|
Martijn VD, Jelle Egbert B, Bart T, Christian D, Frank Jozef Christiaan VDB, Wilhelmina Hendrika S, Michel G, Geert K, David Jonathan H. Pulmonary metastasectomy with lymphadenectomy for colorectal pulmonary metastases: A systematic review. Eur J Surg Oncol 2021; 48:253-260. [PMID: 34656390 DOI: 10.1016/j.ejso.2021.09.020] [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: 04/25/2021] [Revised: 09/19/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Routine lymphadenectomy during metastasectomy for pulmonary metastases of colorectal cancer has been recommended by several recent expert consensus meetings. However, evidence supporting lymphadenectomy is limited. The aim of this study was to perform a systematic review of the literature on the impact of simultaneous lymph node metastases on patient survival during metastasectomy for colorectal pulmonary metastases (CRPM). METHODS A systematic review was conducted according to the PRISMA guidelines of studies on lymphadenectomy during pulmonary metastasectomy for CRPM. Articles published between 2000 and 2020 were identified from Medline, Embase and the Cochrane Library without language restriction. Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the risk of bias and applicability of included studies. Survival rates were assessed and compared for the presence and level of nodal involvement. RESULTS Following review of 8054 studies by paper and abstract, 27 studies comprising 3619 patients were included in the analysis. All patients included in these studies underwent lymphadenectomy during pulmonary metastasectomy for CRPM. A total of 690 patients (19.1%) had simultaneous lymph node metastases. Five-year overall survival for patients with and without lymph node metastases was 18.2% and 51.3%, respectively (p < .001). Median survival for patients with lymph node metastases was 27.9 months compared to 58.9 months in patients without lymph node metastases (p < .001). Five-year overall survival for patients with N1 and N2 lymph node metastases was 40.7% and 10.9%, respectively (p = .064). CONCLUSION Simultaneous lymph node metastases of CRPM have a detrimental impact on survival and this is most apparent for mediastinal lymph node metastases. Therefore, lymphadenectomy during pulmonary metastasectomy for CRPM can be advised to obtain important prognostic value.
Collapse
Affiliation(s)
- van Dorp Martijn
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands.
| | | | - Torensma Bart
- Leiden University Medical Centre, Department of Anesthesiology, Albinusdreef 2, Leiden, the Netherlands
| | - Dickhoff Christian
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiothoracic Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | | | | | - Gonzalez Michel
- Centre Hospitalier Vaudois, Department of Thoracic Surgery, Rue du Bugnon 46, Lausanne, Switzerland
| | - Kazemier Geert
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Heineman David Jonathan
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiothoracic Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| |
Collapse
|
3
|
Bagmet NN, Shatveryan GA, Sekacheva MI, Chardarov NK, Bedzhanyan AL, Galyan TN, Kamalov YR, Fedorov DN. [The role of lymphadenectomy for treatment of colorectal liver metastases with regional lymph nodes involvement]. Khirurgiia (Mosk) 2018:45-49. [PMID: 30560844 DOI: 10.17116/hirurgia201812145] [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
Liver resection remains the method of choice for treatment of colorectal liver metastases with good long-term results. Regional lymph nodes involvement is significant negative prognostic factor. Moreover, it has been considered as a contraindication for liver resection for a long time. The role of lymphadenectomy remains controversial. Current state of this problem is reviewed in the article. Liver regional lymph nodes involvement takes place in 10-20% of cases. PET/CT is the most sensitive method of preoperative diagnosis. Involvement of liver regional lymph nodes is currently not absolute contraindication for liver resection. Routine lymphadenectomy does not make sense, and, perhaps, is justified only within scientific trials for more accurate disease staging. Indications for lymphadenectomy are suspicious changes of lymph nodes revealed by preoperative visualization methods or by intraoperative exploration. Modern chemotherapy regimens allow to reconsider the prognostic importance of liver regional lymph node metastases and to extend indications for liver resections.
Collapse
Affiliation(s)
- N N Bagmet
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - G A Shatveryan
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - M I Sekacheva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - N K Chardarov
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - A L Bedzhanyan
- Petrovsky Russian Research Center for Surgery, Moscow, Russia; Sechenov First Moscow State Medical University, Moscow, Russia
| | - T N Galyan
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - Yu R Kamalov
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - D N Fedorov
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| |
Collapse
|
4
|
Yeatman TJ, Yang M, Coppola D. Whole Genome Sequencing Analysis of a Stage IV Colon Cancer Patient with a 10-Year Disease-Free Survival following Systemic Chemotherapy/Bevacizumab. Case Rep Gastroenterol 2018; 12:729-736. [PMID: 30631260 PMCID: PMC6323361 DOI: 10.1159/000494751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/15/2018] [Indexed: 12/14/2022] Open
Abstract
It is rare that stage IV colon cancer is cured with chemotherapy. Here we report the long-term survival of a patient who presented with highly advanced disease characterized by a papillary architecture as well as porta hepatis lymph nodes but responded extremely well to FOLFIRI/bevacizumab. His original tumor underwent comprehensive genomic testing that included whole genome DNA sequencing, targeted sequencing, and RNA sequencing. These genetic results suggest the patient's tumor harbored mutations in APC, KRAS, and TP53 as well as in PIK3CB. Moreover, the RNA-seq data suggested that the tumor belonged to the consensus molecular subtype 4, the "inflamed, immune phenotype," with increased angiogenesis. Deep sequencing of highly responsive cancers may yield molecular insights into mechanisms underpinning a remarkable response.
Collapse
Affiliation(s)
- Timothy J. Yeatman
- Gibbs Cancer Center & Research Institute, Spartanburg, South Carolina, USA
| | - Mingli Yang
- Gibbs Cancer Center & Research Institute, Spartanburg, South Carolina, USA
| | - Domenico Coppola
- Department of Anatomic Pathology, Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| |
Collapse
|
5
|
Gurusamy K, Corrigan N, Croft J, Twiddy M, Morris S, Woodward N, Bandula S, Hochhauser D, Napp V, Pullan A, Jakowiw N, Prasad R, Damink SO, van Laarhoven CJHM, de Wilt JHW, Brown J, Davidson BR. Liver resection surgery versus thermal ablation for colorectal LiVer MetAstases (LAVA): study protocol for a randomised controlled trial. Trials 2018; 19:105. [PMID: 29439711 PMCID: PMC5811975 DOI: 10.1186/s13063-018-2499-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/24/2018] [Indexed: 12/22/2022] Open
Abstract
Background Although surgical resection has been considered the only curative option for colorectal liver metastases (CLM), thermal ablation has recently been suggested as an alternative curative treatment. A prospective randomised trial is required to define the efficacy of resection vs ablation for the treatment of colorectal liver metastases. Methods Design and setting: This is a multicentre, open, randomised controlled non-inferiority trial design with internal pilot and will be performed in tertiary liver centres in UK and The Netherlands. Participants: Eligible patients will be those with colorectal liver metastases at high surgical risk because of their age, co-morbidities or tumour burden and who would be suitable for liver resection or thermal ablation. Intervention: Thermal ablation as per local policy. Control: Surgical liver resection performed as per centre protocol. Co-interventions: Further chemotherapy will be offered to patients as per current practice. Outcomes Pilot study: Same as main study and in addition patients and clinicians’ acceptability of the trial to assist in optimisation of recruitment. Primary outcome: Disease-free survival (DFS) at two years post randomisation. Secondary outcomes: Overall survival, timing and site of recurrence, additional therapy after treatment failure, quality of life, complications, length of hospital stay, costs, trial acceptability, DFS measured from end of intervention. Follow-up: 24 months from randomisation; five-year follow-up for overall survival. Sample size: 330 patients to demonstrate non-inferiority of thermal ablation. Discussion This trial will determine the effectiveness and cost-effectiveness of thermal ablation vs surgical resection for high-risk people with colorectal liver metastases, and guide the optimal treatment for these patients. Trial registration ISRCTN Registry, ISRCTN52040363. Registered on 9 March 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2499-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kurinchi Gurusamy
- Royal Free Campus, Division of Surgery and Interventional Science, University College London, 9th Floor, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK
| | - Neil Corrigan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Julie Croft
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Maureen Twiddy
- Institute of Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Nick Woodward
- Department of Radiology, Royal Free Hospital, London, UK
| | - Steve Bandula
- Department of Radiology, University College London Hospital, London, UK
| | | | - Vicky Napp
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Alison Pullan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Nicholas Jakowiw
- Royal Free Campus, Division of Surgery and Interventional Science, University College London, 9th Floor, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK
| | - Raj Prasad
- Department of Surgery and Transplantation, Leeds Teaching Hospital, Leeds, UK
| | - Steven Olde Damink
- Department of General Surgery, Maastricht University, Maastricht, The Netherlands
| | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Radboud, The Netherlands
| | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Brian R Davidson
- Royal Free Campus, Division of Surgery and Interventional Science, University College London, 9th Floor, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK.
| |
Collapse
|
6
|
Yu J, Chen Y, Wu Y, Ye L, Lian Z, Wei H, Sun R, Tian Z. The differential organogenesis and functionality of two liver-draining lymph nodes in mice. J Autoimmun 2017; 84:109-121. [PMID: 28886898 DOI: 10.1016/j.jaut.2017.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 12/13/2022]
Abstract
The liver is an immunological organ. However, fundamental knowledge concerning liver-draining lymph nodes (LNs), which have been newly identified in mice as the portal and celiac LNs, is still lacking. Here, we revealed that the portal LN and celiac LN drain liver lymph through different lymphatic vessels. Although both the portal LN and celiac LN possess typical structures, they have different cell compositions. Interestingly, these two LNs form at different times during fetal development. Moreover, the organogenesis of the celiac LN, but not the portal LN, is controlled by the transcription factor NFIL3. Furthermore, the portal LN and celiac LN also perform different functions. The celiac LN is the predominant site of liver antiviral immune responses, whereas the portal LN functions in the in situ induction of dietary antigen-specific regulatory T cells. In conclusion, the portal LN and celiac LN are two independent liver-draining LNs with different organogenesis histories and separate functions in maintaining immune homeostasis in the liver.
Collapse
Affiliation(s)
- Jiali Yu
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Yongyan Chen
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Yuzhang Wu
- Institute of Immunology, Third Military Medical University, Chongqing, 400038, China.
| | - Lilin Ye
- Institute of Immunology, Third Military Medical University, Chongqing, 400038, China
| | - Zhexiong Lian
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Haiming Wei
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Rui Sun
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Zhigang Tian
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
| |
Collapse
|
7
|
Pindak D, Pavlendova J, Tomas M, Dolnik J, Duchon R, Pechan J. Selective versus routine lymphadenectomy in the treatment of liver metastasis from colorectal cancer: a retrospective cohort study. BMC Surg 2017; 17:34. [PMID: 28376753 PMCID: PMC5381135 DOI: 10.1186/s12893-017-0233-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/31/2017] [Indexed: 11/10/2022] Open
Abstract
Background Limited data are available on the importance of routine lymphadenectomy of the hepatoduodenal ligament in the treatment of liver metastasis from colorectal cancer in the literature. Methods A single center retrospective cohort study was conducted to evaluate morbidity and long-term survival in patients who had undergone selective versus routine lymphadenectomy during surgery for colorectal liver metastasis. From January 2006 to December 2009, eighty-one patients undergoing radical resection due to liver metastasis from colorectal cancer were included. The combination of two surgical teams with different approaches to hepatoduodenal ligament lymphadenectomy at our institution allowed us to select two cohorts of patients undergoing selective or routine lymphadenectomy. Results No significant differences between the cohorts were found in age, American Society of Anesthesiology score or Fong’s prognostic criteria. Patients with pN+ disease had significantly inferior survival compared to patients with pN0 disease (hazard ratio [HR] = 6.33, 95% CI 2.16–18.57, p = 0.0001). No significant difference in postoperative morbidity was observed in the group undergoing routine opposed to selective lymphadenectomy (13.63% vs. 8.69%, p = 0.36). There was no difference in long-term survival between the groups (HR = 0.90, 95% CI 0.52–1.58, p = 0.70). There were also no significant differences in the subgroup of patients with pN0 stage (HR = 1.17, 95% CI 0.6–2.11, p = 0.60). Conclusions These data suggest that there is no survival benefit from the use of routine lymphadenectomy during surgery for colorectal liver metastasis, but these data should be confirmed in a prospective randomized study.
Collapse
Affiliation(s)
- Daniel Pindak
- Department of Surgical Oncology, Slovak Medical University, Bratislava, Slovakia. .,National Cancer Institute, Klenova 1, 833 10, Bratislava 3, Slovakia.
| | - Jana Pavlendova
- Department of Surgical Oncology, Slovak Medical University, Bratislava, Slovakia.,National Cancer Institute, Klenova 1, 833 10, Bratislava 3, Slovakia
| | - Miroslav Tomas
- Department of Surgical Oncology, Slovak Medical University, Bratislava, Slovakia.,National Cancer Institute, Klenova 1, 833 10, Bratislava 3, Slovakia
| | - Jozef Dolnik
- National Cancer Institute, Klenova 1, 833 10, Bratislava 3, Slovakia
| | - Robert Duchon
- National Cancer Institute, Klenova 1, 833 10, Bratislava 3, Slovakia
| | - Juraj Pechan
- Department of Surgical Oncology, Slovak Medical University, Bratislava, Slovakia.,National Cancer Institute, Klenova 1, 833 10, Bratislava 3, Slovakia
| |
Collapse
|
8
|
Torres OJM, Marques MC, Santos FN, Farias ICD, Coutinho AK, Oliveira CVCD, Kalil AN, Mello CALD, Kruger JAP, Fernandes GDS, Quireze C, Murad AM, Silva MJDBE, Zurstrassen CE, Freitas HC, Cruz MR, Weschenfelder R, Linhares MM, Castro LDS, Vollmer C, Dixon E, Ribeiro HSDC, Coimbra FJF. BRAZILIAN CONSENSUS FOR MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 3: CONTROVERSIES AND UNRESECTABLE METASTASES. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:173-179. [PMID: 27759781 PMCID: PMC5074669 DOI: 10.1590/0102-6720201600030011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/26/2016] [Indexed: 12/14/2022]
Abstract
In the last module of this consensus, controversial topics were discussed. Management of the disease after progression during first line chemotherapy was the first discussion. Next, the benefits of liver resection in the presence of extra-hepatic disease were debated, as soon as, the best sequence of treatment. Conversion chemotherapy in the presence of unresectable liver disease was also discussed in this module. Lastly, the approach to the unresectable disease was also discussed, focusing in the best chemotherapy regimens and hole of chemo-embolization.
Collapse
Affiliation(s)
- Orlando Jorge Martins Torres
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian Society of Surgical Oncology (BSSO).,Brazilian Society of Clinical Oncology (BSCO)
| | - Márcio Carmona Marques
- Brazilian Society of Surgical Oncology (BSSO).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | - Fabio Nasser Santos
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA)
| | - Igor Correia de Farias
- Brazilian Society of Surgical Oncology (BSSO).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | | | - Cássio Virgílio Cavalcante de Oliveira
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian College of Digestive Surgery (BCDS).,Brazilian College of Surgeons (BCS)
| | - Antonio Nocchi Kalil
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian Society of Surgical Oncology (BSSO).,Brazilian College of Digestive Surgery (BCDS).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | | | - Jaime Arthur Pirola Kruger
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian College of Digestive Surgery (BCDS).,Brazilian College of Surgeons (BCS).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | | | - Claudemiro Quireze
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian College of Digestive Surgery (BCDS).,Brazilian College of Surgeons (BCS).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | | | | | | | | | | | | | - Marcelo Moura Linhares
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian College of Digestive Surgery (BCDS).,Brazilian College of Surgeons (BCS).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | - Leonaldson Dos Santos Castro
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian Society of Surgical Oncology (BSSO).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | | | - Elijah Dixon
- Americas Hepato-Pancreato-Biliary Association - AHPBA
| | - Héber Salvador de Castro Ribeiro
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian Society of Surgical Oncology (BSSO).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | - Felipe José Fernandez Coimbra
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian Society of Surgical Oncology (BSSO).,Brazilian College of Surgeons (BCS).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| |
Collapse
|
9
|
Yong TL, Houli N, Christophi C. Anatomy of hepatic lymphatics and its implications in hepatic malignancies. ANZ J Surg 2016; 86:868-873. [DOI: 10.1111/ans.13662] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/19/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Tuck Leong Yong
- Department of Surgery; Northern Health; Melbourne Victoria Australia
| | - Nezor Houli
- Department of Surgery; Northern Health; Melbourne Victoria Australia
| | - Chris Christophi
- Department of Surgery; Austin Health; Melbourne Victoria Australia
| |
Collapse
|
10
|
Wei AC, Coburn NG, Devitt KS, Serrano PE, Moulton CA, Cleary SP, Law C, Moore MJ, Gallinger S. Survival Following Resection of Intra- and Extra-Hepatic Metastases from Colorectal Cancer: A Phase II Trial. Ann Surg Oncol 2016; 23:2644-51. [PMID: 27027312 DOI: 10.1245/s10434-016-5189-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE Metastasectomy for intrahepatic metastases (IHM) from colorectal cancer (CRC) provides excellent 5-year overall survival (OS). Presence of extrahepatic metastases (EHM) has been a historic contraindication to surgery. Due to improved safety of hepatectomy, there is growing interest in multisite metastasectomy for IHM and EHM. The objective of this study was to evaluate the results of metastasectomy for patients with IHM and EHM from CRC. METHODS A phase II study of metastasectomy for both IHM and EHM from CRC. Eligible patients with any number of IHM and up to three EHM foci, resectable with RO intent, were offered metastasectomy. Clinical, survival, and quality of life (QoL) data were analyzed using standard statistical methods. RESULTS Twenty-six patients were enrolled with a median age of 58 (range 32-84) years; 14/26 (54 %) presented with synchronous disease. The lung was the most common EHM site (13/26, 50 %). Protocol surgery was completed in 20/26 (77 %), including 12/26 (46 %) planned sequential resections. Major morbidity and perioperative mortality were 5/26 (19 %) and 1/26 (4 %), respectively. The QoL decline appeared to be transient. All QoL domains returned to baseline by 1-year posttreatment. The median recurrence-free survival (RFS) was 5 months by intent-to-treat analysis. The median OS from the time of CRC diagnosis and metastasectomy were 50 and 38 months (3-year OS 80 and 53 %), respectively. CONCLUSIONS Complete metastasectomy of multisite CRC is safe, but disease recurs in the majority of patients. Data suggest that aggressive multisite metastasectomy may provide OS benefit for selected patients.
Collapse
Affiliation(s)
- Alice C Wei
- Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Department of Surgery, University of Toronto, Toronto, Canada.
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Canada
| | - Katharine S Devitt
- Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Pablo E Serrano
- Hepatobiliary & Pancreatic Surgical Oncology, Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada.,Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Carol-Anne Moulton
- Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Sean P Cleary
- Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Calvin Law
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Canada
| | | | - Steven Gallinger
- Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| |
Collapse
|
11
|
Lymphatic drainage of the liver and its implications in the management of colorectal cancer liver metastases. Updates Surg 2014; 66:239-45. [PMID: 25168641 DOI: 10.1007/s13304-014-0265-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/22/2014] [Indexed: 12/11/2022]
Abstract
The liver is the most common site of distant metastases in patients with colorectal cancer. Surgery represents the mainstream for curative treatment of colorectal cancer liver metastases (CRCLM) with long-term survival up to 58 and 36 % at 5 and 10 years, respectively. Despite advances on diagnosis, staging and surgical strategies, 60-70 % of patients will develop recurrence of the disease even after R0 resection of CRCLM. Tumor staging, prognosis, and therapeutic approaches for cancer are most often based on the extent of involvement of regional lymph nodes (LNs) and, to a lesser extent, on the invasion of regional lymphatic vessels draining the primary tumor. For CRCLM, the presence of intra hepatic lymphatic and blood vascular dissemination has been associated with an increased risk of intra hepatic recurrence, poorer disease-free and overall survival after liver resection. Also, several studies have reviewed the role of surgery in the patient with concomitant CRCLM and liver pedicle LN metastasis. Although pedicle LN involvement is related to worst survival rates, it does not differentiate patients that will relapse from those that will not. This review aims to briefly describe the anatomy of the liver's lymphatic drainage, the incidence of intrahepatic lymphatic invasion and hilar lymph node involvement, as well as their clinical impact in CRCLM. A better understanding of the role of liver lymphatic metastasis might, in the near future, impact the strategy of systemic therapies after liver resection as for primary colorectal tumors.
Collapse
|
12
|
Christophi C, Nguyen L, Muralidharan V, Nikfarjam M, Banting J. Lymphatics and colorectal liver metastases: the case for sentinel node mapping. HPB (Oxford) 2014; 16:124-30. [PMID: 23869986 PMCID: PMC3921007 DOI: 10.1111/hpb.12118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 03/21/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic resection remains the treatment of choice for patients with colorectal liver metastases (CLM). Indications for hepatic resection have been extended to include extrahepatic lymph node groups, resulting in increased survival benefits. The identification of specific lymph pathways and involved nodes is necessary to support the development of guidelines for a more focused approach to the management of this disease. The feasibility of sentinel node mapping should be investigated to define specific lymphatic groups involved in CLM. METHODS Scientific papers published from 1950 to 2012 were sought and extracted from the MEDLINE, PubMed and University of Melbourne databases. RESULTS Several studies have reported microscopic lymph node involvement in 10-15% of patients undergoing hepatic resection for CLM in which no macroscopic involvement was evident. In retrospect, over 80% of lymphadenectomies are proven unnecessary. Traditional imaging modalities have limited predictive value in detecting lymph node involvement. Sentinel node mapping has proved an extremely accurate tool in detecting lymph node involvement and can identify patients in whom lymphadenectomy may be beneficial. CONCLUSIONS Current imaging techniques are inadequate to detect microscopic lymph node involvement in patients with resectable CLM. The use of sentinel node mapping is proposed to identify nodal groups involved and provide management strategies.
Collapse
Affiliation(s)
- Christopher Christophi
- Christopher Christophi, Department of Surgery, University of Melbourne, Austin Hospital, Lance Townsend Building Level 8, Studley Road, Heidelberg, Vic 3084, Australia. Tel: + 61 3 9496 5492. Fax: + 61 3 9458 1650. E-mail:
| | | | | | | | | |
Collapse
|
13
|
McNally SJ, Parks RW. Surgery for colorectal liver metastases. Dig Surg 2013; 30:337-47. [PMID: 24051581 DOI: 10.1159/000351442] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 04/10/2013] [Indexed: 12/27/2022]
Abstract
Half of all patients with colorectal cancer develop metastatic disease. The liver is the principal site for metastases, and surgical resection is the only modality that offers the potential for long-term cure. Appropriate patient selection for surgery and improvements in perioperative care have resulted in low morbidity and mortality rates, resulting in this being the therapy of choice for suitable patients. Modern management of colorectal liver metastases is multimodal incorporating open and laparoscopic surgery, ablative therapies such as radiofrequency ablation or microwave ablation and (neo)adjuvant chemotherapy. The majority of patients with hepatic metastases should be considered for resectional surgery, if all disease can be resected, as this offers the only opportunity for prolonged survival.
Collapse
Affiliation(s)
- S J McNally
- Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | |
Collapse
|
14
|
Management of the Hepatic Lymph Nodes During Resection of Liver Metastases from Colorectal Cancer: A Systematic Review. CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-013-0165-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
15
|
Dhir M, Lyden ER, Smith LM, Are C. Influence of margins on disease free survival following hepatic resection for colorectal metastasis: a meta-analysis. Indian J Surg Oncol 2012; 3:321-9. [PMID: 24293972 DOI: 10.1007/s13193-012-0183-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 08/09/2012] [Indexed: 12/18/2022] Open
Abstract
The aim of our study was to conduct a meta-analysis of reports published on hepatic resection for colorectal liver metastases (CRLM) and determine if a negative margin ≥1 cm confers a disease free survival (DFS) advantage over sub-centimeter negative margins. The 357 initially selected articles were screened to identify 90 articles of interest of which eleven were finally included in the meta-analysis. Patients with positive margins were excluded from the meta-analysis. Meta-analysis was performed using STATA 9.2 statistical software. A total of 1,989 patients with negative margins from the eleven studies were included in the meta-analysis. The 5-year DFS for all patients was 27.9 % (95 % CI 23.5 % to 32.2 %). The 5-year DFS for ≥1 cm negative margin subgroup was 34.4 % (95 % CI 27.97 % to 40.7 %) when compared to 21.0 % (95 % CI 17.4 % to 24.7 %) for <1 cm negative margin subgroup. The odds ratio for ≥1 cm negative margins was found to be 0.552 (95 % CI 0.408 to 0.747, p < 0.001) when compared to <1 cm negative margins. The results of this meta-analysis demonstrate that in patients undergoing hepatic resection for CRLM, a negative margin ≥ 1 cm may confer a better DFS compared with a sub-centimeter negative margin.
Collapse
Affiliation(s)
- Mashaal Dhir
- Department of Surgery, Division of Surgical Oncology, Eppley Cancer Center, University of Nebraska Medical Center, Omaha, NE USA
| | | | | | | |
Collapse
|
16
|
Routine pedicular lymphadenectomy for colorectal liver metastases. J Am Coll Surg 2012; 214:e39-45. [PMID: 22521440 DOI: 10.1016/j.jamcollsurg.2012.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 02/15/2012] [Indexed: 12/22/2022]
|
17
|
Grundmann RT. Current state of surgical treatment of liver metastases from colorectal cancer. World J Gastrointest Surg 2011; 3:183-96. [PMID: 22224173 PMCID: PMC3251742 DOI: 10.4240/wjgs.v3.i12.183] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 10/23/2011] [Accepted: 11/01/2011] [Indexed: 02/06/2023] Open
Abstract
Hepatic resection is the procedure of choice for curative treatment of colorectal liver metastases (CLM). Objectives of surgical strategy are low intraoperative blood loss, short liver ischemic times and minor postoperative morbidity and mortality. Blood loss is an independent predictor of mortality and compromises, in common with postoperative complications, long-term outcome after hepatectomy for CLM. The type of liver resection has no impact on the outcome of patients with CLM; wedge resections are not inferior to anatomical resections in terms of tumor clearance, pattern of recurrence or survival. Despite the lack of proof of survival benefit, routine lymphadenectomy has been advocated, allowing the detection of microscopic lymph node metastases and with prognostic value. In experienced hands, minimally invasive liver surgery is safe with acceptable morbidity and mortality and oncological results comparable to open hepatic surgery, but with reduced blood loss and earlier recovery. The European Colorectal Metastases Treatment Group recommended treating up front with chemotherapy for patients with both resectable and unresectable CLM. However, neoadjuvant chemotherapy can induce damage to the remnant liver, dependent on the number of chemotherapy cycles. Therefore, in our opinion, preoperative chemotherapy should be reserved for patients whose CLM are marginally resectable or unresectable. A meta analysis of randomized trials dealing with perioperative chemotherapy for the treatment of resectable CLM demonstrated a benefit of systemic chemotherapy but did not answer the question of whether a neoadjuvant or adjuvant approach should be preferred. Analysis of the literature demonstrates that the results of specialized centers cannot be attained in the reality of comprehensive patient care. Reasons behind the commonly poorer results seen in cancer networks as compared with literature-based data are, on the one hand, geographical disparities in access to specialized surgical and medical care. On the other hand, a selection bias in the reports of the literature may be assumed. Studies of surgical resection for CLM derive almost exclusively from case series generally drawn from large academic centers where patient selection or surgical expertise is superior to what is found in many communities. Therefore, we may conclude that the comprehensive propagation of the standards outlined in this paper constitutes a major task in the near future to reduce the variations in survival of patients with CLM.
Collapse
Affiliation(s)
- Reinhart T Grundmann
- Reinhart T Grundmann, Kreiskliniken Altötting-Burghausen, In den Grüben 144, D-84489 Burghausen, Germany
| |
Collapse
|
18
|
Influence of Margins on Overall Survival After Hepatic Resection for Colorectal Metastasis. Ann Surg 2011; 254:234-42. [DOI: 10.1097/sla.0b013e318223c609] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
19
|
Settmacher U, Dittmar Y, Knösel T, Schöne U, Heise M, Jandt K, Altendorf-Hofmann AK. Predictors of long-term survival in patients with colorectal liver metastases: a single center study and review of the literature. Int J Colorectal Dis 2011; 26:967-81. [PMID: 21584664 DOI: 10.1007/s00384-011-1195-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE Prognosis after resection of liver metastases of colorectal cancer is influenced by a variety of clinical factors. For more than 20 years, efforts have been made to restructure and simplify prognostic parameters into clinical scores. We evaluated the influence of various clinical and pathological factors on survival and recurrence and developed a simple model for risk stratification. METHODS We have analyzed a total of 13 prognostic factors in 382 consecutive and prospectively enrolled R0-resected patients and applied our data set to ten published prognostic scoring systems. Prognostic factors that influenced disease-specific and disease-free survival were included into a model clinical risk score. RESULTS The 5- and 10-year observed survival rates were 43% and 28%, respectively, for all 382 patients. The disease-specific 5- and 10-year survival rates were 49% and 37%, respectively; the 5- and 10-year recurrence rates were 68% and 70%, respectively. For patients with synchronous liver metastases, survival was not affected by the timing of liver resection. The prognosis after treatment of any recurrence was best after the accomplishment of a repeated R0 situation, independent of the location of the recurrence. In the multivariate analysis, the disease-specific survival and recurrence rates were statistically significantly influenced by more than three lymph node metastases of the primary tumor, more than two lesions within the liver, and the presence of extrahepatic tumor. CONCLUSIONS From these data, we have developed a simple score for the risk stratification which may be useful for future studies on interdisciplinary management of colorectal liver metastases.
Collapse
Affiliation(s)
- Utz Settmacher
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Erlanger Allee 101, Jena, 07740, Germany.
| | | | | | | | | | | | | |
Collapse
|
20
|
Tonelli F, Leo F, Nobili S, Mini E, Batignani G. Prognostic factors in primary and iterative surgery of colorectal liver metastases. J Chemother 2011; 22:358-63. [PMID: 21123161 DOI: 10.1179/joc.2010.22.5.358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of this study was to evaluate the results of surgery of colorectal liver metastases and assess prognostic factors influencing the outcome. A total of 135 hepatic resections performed in 107 patients was reviewed. The following prognostic factors were analyzed: primary tumor localization, Dukes stage, number and presence of metastases in one or two lobes, synchronous or metachronous occurrence, type of resection, use and modality of chemotherapy. The perioperative morbidity rate was 6.5% and mortality was 1.9%. Overall survival was 41.2% and disease-free survival 31.5% at 5 years. Survival at 5 years was better for patients with metachronous than for those with synchronous lesions (60.9% vs 28.1%; p<0.05). There were no significant differences in terms of long-term survival between patients with synchronous metastases that were excised simultaneously or with a delay of 3-6 months (p=n.s.). Site of the primary tumor, Dukes stage, number of metastases and type of resection did not influence survival. A favorable survival trend was observed in those patients who underwent both neoadjuvant and adjuvant chemotherapy. The overall survival rate at 5 years was 45.3% for patients undergoing a second hepatic resection and 50% for those with a third or a fourth hepatic resection. Liver resection remains the "gold standard" for the treatment of patients with colorectal liver metastases, with metachronous type having a better outcome than synchronous. Simultaneous or delayed surgery for synchronous metastases does not influence prognosis. Iterative resection is very encouraging and justifies an aggressive surgical approach.
Collapse
Affiliation(s)
- F Tonelli
- Department of Clinical Physiopathology, University of Florence, Italy.
| | | | | | | | | |
Collapse
|
21
|
Safety and prognostic role of regional lymphadenectomy for primary and metastatic liver tumors. Updates Surg 2010; 62:27-34. [DOI: 10.1007/s13304-010-0008-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
22
|
Reddy SK, Clary BM. A New Era in Defining Indications for Resectability of Colorectal Cancer Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2010. [DOI: 10.1007/s11888-010-0049-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
|
23
|
Gurusamy KS, Ramamoorthy R, Imber C, Davidson BR. Surgical resection versus non-surgical treatment for hepatic node positive patients with colorectal liver metastases. Cochrane Database Syst Rev 2010; 2010:CD006797. [PMID: 20091607 PMCID: PMC7389879 DOI: 10.1002/14651858.cd006797.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Involvement of hepatic lymph node in patients with colorectal liver metastases is associated with poor prognosis. OBJECTIVES To determine the benefits and harms of curative liver resection with lymphadenectomy versus other treatments for colorectal liver metastases with hepatic node involvement. SEARCH STRATEGY We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and LILACS until September 2009 for identifying the randomised trials. SELECTION CRITERIA We considered only randomised clinical trials (irrespective of language, blinding, or publication status) comparing liver resection (alone or in combination with radiofrequency ablation or cryoablation) versus other treatments (neo-adjuvant chemotherapy, chemotherapy, or radiofrequency ablation) in patients with colorectal liver metastases with hepatic node involvement. DATA COLLECTION AND ANALYSIS Two authors independently identified trials for inclusion. MAIN RESULTS We were unable to identify any randomised clinical trial fulfilling the inclusion criteria of this review. We were also unable to identify any quasi-randomised or cohort studies, which could meaningfully answer this important issue. AUTHORS' CONCLUSIONS There is no evidence in the literature to assess the role of surgery versus other treatments for patients with colorectal liver metastases with hepatic node involvement. High quality randomised clinical trials are feasible and are necessary to determine the optimal management of patients with colorectal liver metastases with hepatic node involvement.
Collapse
Affiliation(s)
- Kurinchi Selvan Gurusamy
- Royal Free Hospital and University College School of MedicineUniversity Department of Surgery9th Floor, Royal Free HospitalPond StreetLondonUKNW3 2QG
| | - Rajarajan Ramamoorthy
- Royal Free Hospital and University College School of MedicineUniversity Department of Surgery9th Floor, Royal Free HospitalPond StreetLondonUKNW3 2QG
| | - Charles Imber
- University College London HospitalGeneral Surgery235 Euston RoadLondonUKNW1 2BU
| | - Brian R Davidson
- Royal Free Hospital and University College School of MedicineUniversity Department of Surgery9th Floor, Royal Free HospitalPond StreetLondonUKNW3 2QG
| | | |
Collapse
|
24
|
Abstract
Surgical R0 resection of primary and secondary hepatobiliary tumors, such as colorectal liver metastases, hepatocellular carcinoma, cholangiocellular carcinoma and gall bladder carcinoma, remains the only potentially curative treatment option. The extent of involvement of lymph node metastases seems to be an independent prognostic factor in these tumors. The prognostic value of a systematic lymph node dissection in hepatobiliary tumors still remains unclear as there is a lack of prospective randomized trials. However, local lymphadenectomy (hepatoduodenal ligament and retropancreaticoduodenal lymph nodes) can be easily performed with low mortality and morbidity rates and may be helpful in better staging of the patients. Further randomized trials are necessary in order to define the relevance of lymph node dissection in hepatobiliary surgery.
Collapse
|
25
|
Abstract
Neuroendocrine malignancies encompass a variety of tumors that differ considerably in origin, hormonal activity, and biological behavior. Because of their rarity most therapeutic recommendations have been based on limited evidence from small retrospective series observing miscellaneous patient cohorts. Only in recent years proposals for TNM and histological grading systems have been elaborated that allow further stratification of patients suffering from these tumors. Especially patients with well and moderately differentiated neuroendocrine malignancies benefit from resection of liver metastases, improving the 5-year survival rate from <50% to 80%. Orthotopic liver transplantation can likewise improve survival in carefully selected patients. New developments in imaging modalities, intensive care treatment, and in liver surgery itself have broadened the selection of potentially resectable tumors.
Collapse
|
26
|
Tarasov KV, Testa G, Tarasova YS, Kania G, Riordon DR, Volkova M, Anisimov SV, Wobus AM, Boheler KR. Linkage of pluripotent stem cell-associated transcripts to regulatory gene networks. Cells Tissues Organs 2008; 188:31-45. [PMID: 18303244 DOI: 10.1159/000118787] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Knowledge of the transcriptional circuitry responsible for pluripotentiality and self-renewal in embryonic stem cells is tantamount to understanding early mammalian development and a prerequisite to determining their therapeutic potential. Various techniques have employed genomics to identify transcripts that were abundant in stem cells, in an attempt to define the molecular basis of 'stemness'. In this study, we have extended traditional genomic analyses to identify cis-elements that might be implicated in the control of embryonic stem cell-restricted gene promoters. The strategy relied on the generation of a problem-specific list from serial analysis of gene expression profiles and subsequent promoter analyses to identify frameworks of multiple cis-elements conserved in space and orientation among genes from the problem-specific list. Subsequent experimental data suggest that 2 novel transcription factors, B-Myb and Maz, predicted from these models, are implicated either in the maintenance of the undifferentiated stem cell state or in early steps of differentiation.
Collapse
Affiliation(s)
- Kirill V Tarasov
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | | | | | | | | | | | | | | | | |
Collapse
|