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Hess GF, Aegerter NLE, Zeindler J, Vosbeck J, Neuschütz KJ, Müller PC, Muenst S, Däster S, Bolli M, Kollmar O, Soysal SD. Impact of Positive Lymph Nodes after Systematic Perihilar Lymphadenectomy in Colorectal Liver Metastases. J Clin Med 2024; 13:5301. [PMID: 39274514 PMCID: PMC11395892 DOI: 10.3390/jcm13175301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/21/2024] [Accepted: 09/04/2024] [Indexed: 09/16/2024] Open
Abstract
Background: 25 to 50% of patients suffering from colorectal cancer develop liver metastases. The incidence of regional lymph node (LN) metastases within the liver is up to 14%. The need for perihilar lymph node dissection (LND) is still a controversial topic in patients with colorectal liver metastases (CRLM). This study investigates the role of perihilar LND in patients with CRLM. Methods: For this retrospective study, patients undergoing surgery for CRLM at the University Hospital Basel between May 2009 and December 2021 were included. In patients with perihilar LND, LN were stained for CK22 and examined for single tumour cells (<0.2 mm), micro- (0.2-2 mm), and macro-metastases (>2 mm). Results: 112 patients undergoing surgery for CRLM were included. 54 patients underwent LND, 58/112 underwent liver resection only (LR). 3/54 (5.6%) showed perihilar LN metastases in preoperative imaging, and in 10/54 (18.5%), micro-metastases could be proven after CK22 staining. Overall complications were similar in both groups (LND: 46, 85.2%; LR: 48, 79.3%; p = 0.800). The rate of major complications was higher in the LND group (LND: 22, 40.7%; LR: 18, 31%, p = 0.002). Median recurrence-free survival (RFS) (LND: 10 months; LR: 15 months, p = 0.076) and overall survival (OS) were similar (LND: 49 months; LR: 60 months, p = 0.959). Conclusion: Preoperative imaging is not sensitive enough to detect perihilar LN metastases. Perihilar LND enables precise tumour staging by detecting more lymph node metastases, especially through CK22 staining. However, perihilar LND does not influence oncologic outcomes in patients with CRLM.
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Affiliation(s)
- Gabriel F Hess
- Clarunis, University Digestive Health Care Centre Basel, 4002 Basel, Switzerland
| | - Noa L E Aegerter
- Clarunis, University Digestive Health Care Centre Basel, 4002 Basel, Switzerland
| | - Jasmin Zeindler
- Clarunis, University Digestive Health Care Centre Basel, 4002 Basel, Switzerland
| | - Jürg Vosbeck
- Institute of Medical Genetics and Pathology, University Hospital Basel, Schönbeinstrasse 40, 4031 Basel, Switzerland
| | - Kerstin J Neuschütz
- Clarunis, University Digestive Health Care Centre Basel, 4002 Basel, Switzerland
| | - Philip C Müller
- Clarunis, University Digestive Health Care Centre Basel, 4002 Basel, Switzerland
| | - Simone Muenst
- Institute of Medical Genetics and Pathology, University Hospital Basel, Schönbeinstrasse 40, 4031 Basel, Switzerland
| | - Silvio Däster
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Martin Bolli
- Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Luzern, Switzerland
| | - Otto Kollmar
- Clarunis, University Digestive Health Care Centre Basel, 4002 Basel, Switzerland
| | - Savas D Soysal
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
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Stewart CL, Warner S, Ito K, Raoof M, Wu GX, Kessler J, Kim JY, Fong Y. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure? Curr Probl Surg 2018; 55:330-379. [PMID: 30526930 DOI: 10.1067/j.cpsurg.2018.08.004] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Camille L Stewart
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Susanne Warner
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Kaori Ito
- Department of Surgery, Michigan State University, Lansing, MI
| | - Mustafa Raoof
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Geena X Wu
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Jonathan Kessler
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Yuman Fong
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA.
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Perini MV, Tai J, Muralidharan V, Christophi C. Sentinel lymph node mapping in liver resection for colorectal liver metastases. ANZ J Surg 2018; 89:978-980. [DOI: 10.1111/ans.14405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 12/26/2017] [Accepted: 12/29/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Marcos V. Perini
- Hepato‐Pancreato‐Biliary and Transplantation UnitAustin Health Melbourne Victoria Australia
- Department of SurgeryAustin Health, The University of Melbourne Melbourne Victoria Australia
| | - James Tai
- Hepato‐Pancreato‐Biliary and Transplantation UnitAustin Health Melbourne Victoria Australia
- Department of SurgeryAustin Health, The University of Melbourne Melbourne Victoria Australia
| | - Vijayaragavan Muralidharan
- Hepato‐Pancreato‐Biliary and Transplantation UnitAustin Health Melbourne Victoria Australia
- Department of SurgeryAustin Health, The University of Melbourne Melbourne Victoria Australia
| | - Christopher Christophi
- Hepato‐Pancreato‐Biliary and Transplantation UnitAustin Health Melbourne Victoria Australia
- Department of SurgeryAustin Health, The University of Melbourne Melbourne Victoria Australia
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Baek JH, Kim KK, Lee JN, Ha SY, Lee WK, Lee WS. Prophylactic perihepatic lymphadenectomy in patients with colorectal cancer with liver metastasis: A prospective preliminary study. SURGICAL PRACTICE 2017. [DOI: 10.1111/1744-1633.12238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jeong Heum Baek
- Department of Surgery; Gachon University School of Medicine; Incheon Korea
| | - Keon-Kuk Kim
- Department of Surgery; Gachon University School of Medicine; Incheon Korea
| | - Jung-Nam Lee
- Department of Surgery; Gachon University School of Medicine; Incheon Korea
| | - Seung-Yeon Ha
- Department of Surgery; Gachon University School of Medicine; Incheon Korea
- Department of Pathology; Gachon University School of Medicine; Incheon Korea
| | - Woon Kee Lee
- Department of Surgery; Gachon University School of Medicine; Incheon Korea
| | - Won-Suk Lee
- Department of Surgery; Gachon University School of Medicine; Incheon Korea
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Hodgson R, Sethi H, Ling AH, Lodge P. Combined hepatectomy and hepatic pedicle lymphadenectomy in colorectal liver metastases is justified. HPB (Oxford) 2017; 19:525-529. [PMID: 28215513 DOI: 10.1016/j.hpb.2017.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/21/2017] [Accepted: 01/24/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to describe the outcome of patients with colorectal liver metastases (CRLM) and radiological or clinical evidence of metastatic hepatic lymph node involvement who underwent combined hepatectomy and hepatic pedicle lymphadenectomy. METHODS Retrospective analysis of a prospectively maintained audit of 2082 patients undergoing liver resection for CRLM between 1994 and 2014. Age, type of resection, CT/MRI/PET detection, location, disease recurrence and survival were analysed. RESULTS Combined hepatectomy and hepatic pedicle lymphadenopathy was performed on 76 patients who met the inclusion criteria. 46% of enlarged lymph nodes were located in the hepatic ligament, with 38% retroportal, 38% common hepatic and 33% coeliac nodes. 50% of lymph node resections were positive for metastatic tumour. Pre-operative CT, MRI and CT/PET failed to detect histologically proven lymph node disease in 25/38 patients. Patients with negative nodal histology had a significant overall (44 vs 20 months, p = 0.008) and disease free (20 vs 11 months, p < 0.001) survival advantage. CONCLUSION Combined hepatectomy and lymph node resection for CRLM in the setting of enlarged or suspicious lymphadenopathy is justified as imaging and operative findings are poor guides in determining positive lymph node disease.
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Affiliation(s)
- Russell Hodgson
- St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK.
| | - Harsheet Sethi
- St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK
| | - Andrew H Ling
- St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK
| | - Peter Lodge
- St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK
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6
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Groot Koerkamp B, Sadot E, Kemeny NE, Gönen M, Leal JN, Allen PJ, Cercek A, DeMatteo RP, Kingham TP, Jarnagin WR, D'Angelica MI. Perioperative Hepatic Arterial Infusion Pump Chemotherapy Is Associated With Longer Survival After Resection of Colorectal Liver Metastases: A Propensity Score Analysis. J Clin Oncol 2017; 35:1938-1944. [PMID: 28426374 DOI: 10.1200/jco.2016.71.8346] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose To investigate whether perioperative hepatic arterial infusion pump chemotherapy (HAI) was associated with overall survival (OS) in patients who had a complete resection of colorectal liver metastases (CLM). Methods Patients who underwent a complete resection of CLM between 1992 and 2012 were included from a single-center prospectively maintained database. All patients who received HAI also received perioperative systemic chemotherapy. Propensity score analysis was used to match patients for seven known prognostic factors. Results A total of 2,368 consecutive patients underwent a complete resection of CLM, with a median follow-up of 55 months. The median OS for patients with HAI (n = 785) was 67 months versus 44 months without HAI (n = 1,583; P < .001), despite more advanced disease in the HAI group. OS at 10 years was 38.0% versus 23.8% without HAI. For patients who received modern systemic chemotherapy (n = 1,442), the median OS was 67 months with HAI and 47 months without HAI ( P < .001). The hazard ratio adjusted by propensity score demonstrated longer OS with HAI: 0.67 (95% CI, 0.59 to 0.76; P < .001). A pronounced difference in median OS was found for patients with node-negative colorectal cancer (129 months with HAI v 51 months without; P < .001) and a low clinical risk score of 0 to 2 points (89 months with HAI v 53 months without; P < .001). Conclusion Patients who received HAI had a median OS of approximately 2 years longer than patients without HAI. The strong association was independent of the use of modern systemic chemotherapy and remained in propensity score analysis. Patients with node-negative primary tumors or a low clinical risk score seemed to benefit most from HAI.
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Affiliation(s)
- Bas Groot Koerkamp
- Bas Groot Koerkamp, Eran Sadot, Nancy E. Kemeny, Mithat Gönen, Julie N. Leal, Peter J. Allen, Andrea Cercek, Ronald P. DeMatteo, T. Peter Kingham, William R. Jarnagin, and Michael I. D'Angelica, Memorial Sloan Kettering Cancer Center, New York, NY; Bas Groot Koerkamp, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Eran Sadot, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Tel Aviv, Israel
| | - Eran Sadot
- Bas Groot Koerkamp, Eran Sadot, Nancy E. Kemeny, Mithat Gönen, Julie N. Leal, Peter J. Allen, Andrea Cercek, Ronald P. DeMatteo, T. Peter Kingham, William R. Jarnagin, and Michael I. D'Angelica, Memorial Sloan Kettering Cancer Center, New York, NY; Bas Groot Koerkamp, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Eran Sadot, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Tel Aviv, Israel
| | - Nancy E Kemeny
- Bas Groot Koerkamp, Eran Sadot, Nancy E. Kemeny, Mithat Gönen, Julie N. Leal, Peter J. Allen, Andrea Cercek, Ronald P. DeMatteo, T. Peter Kingham, William R. Jarnagin, and Michael I. D'Angelica, Memorial Sloan Kettering Cancer Center, New York, NY; Bas Groot Koerkamp, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Eran Sadot, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Tel Aviv, Israel
| | - Mithat Gönen
- Bas Groot Koerkamp, Eran Sadot, Nancy E. Kemeny, Mithat Gönen, Julie N. Leal, Peter J. Allen, Andrea Cercek, Ronald P. DeMatteo, T. Peter Kingham, William R. Jarnagin, and Michael I. D'Angelica, Memorial Sloan Kettering Cancer Center, New York, NY; Bas Groot Koerkamp, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Eran Sadot, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Tel Aviv, Israel
| | - Julie N Leal
- Bas Groot Koerkamp, Eran Sadot, Nancy E. Kemeny, Mithat Gönen, Julie N. Leal, Peter J. Allen, Andrea Cercek, Ronald P. DeMatteo, T. Peter Kingham, William R. Jarnagin, and Michael I. D'Angelica, Memorial Sloan Kettering Cancer Center, New York, NY; Bas Groot Koerkamp, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Eran Sadot, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Tel Aviv, Israel
| | - Peter J Allen
- Bas Groot Koerkamp, Eran Sadot, Nancy E. Kemeny, Mithat Gönen, Julie N. Leal, Peter J. Allen, Andrea Cercek, Ronald P. DeMatteo, T. Peter Kingham, William R. Jarnagin, and Michael I. D'Angelica, Memorial Sloan Kettering Cancer Center, New York, NY; Bas Groot Koerkamp, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Eran Sadot, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Tel Aviv, Israel
| | - Andrea Cercek
- Bas Groot Koerkamp, Eran Sadot, Nancy E. Kemeny, Mithat Gönen, Julie N. Leal, Peter J. Allen, Andrea Cercek, Ronald P. DeMatteo, T. Peter Kingham, William R. Jarnagin, and Michael I. D'Angelica, Memorial Sloan Kettering Cancer Center, New York, NY; Bas Groot Koerkamp, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Eran Sadot, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Tel Aviv, Israel
| | - Ronald P DeMatteo
- Bas Groot Koerkamp, Eran Sadot, Nancy E. Kemeny, Mithat Gönen, Julie N. Leal, Peter J. Allen, Andrea Cercek, Ronald P. DeMatteo, T. Peter Kingham, William R. Jarnagin, and Michael I. D'Angelica, Memorial Sloan Kettering Cancer Center, New York, NY; Bas Groot Koerkamp, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Eran Sadot, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Tel Aviv, Israel
| | - T Peter Kingham
- Bas Groot Koerkamp, Eran Sadot, Nancy E. Kemeny, Mithat Gönen, Julie N. Leal, Peter J. Allen, Andrea Cercek, Ronald P. DeMatteo, T. Peter Kingham, William R. Jarnagin, and Michael I. D'Angelica, Memorial Sloan Kettering Cancer Center, New York, NY; Bas Groot Koerkamp, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Eran Sadot, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Tel Aviv, Israel
| | - William R Jarnagin
- Bas Groot Koerkamp, Eran Sadot, Nancy E. Kemeny, Mithat Gönen, Julie N. Leal, Peter J. Allen, Andrea Cercek, Ronald P. DeMatteo, T. Peter Kingham, William R. Jarnagin, and Michael I. D'Angelica, Memorial Sloan Kettering Cancer Center, New York, NY; Bas Groot Koerkamp, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Eran Sadot, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Tel Aviv, Israel
| | - Michael I D'Angelica
- Bas Groot Koerkamp, Eran Sadot, Nancy E. Kemeny, Mithat Gönen, Julie N. Leal, Peter J. Allen, Andrea Cercek, Ronald P. DeMatteo, T. Peter Kingham, William R. Jarnagin, and Michael I. D'Angelica, Memorial Sloan Kettering Cancer Center, New York, NY; Bas Groot Koerkamp, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Eran Sadot, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Tel Aviv, Israel
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Nanji S, Tsang ME, Wei X, Booth CM. Regional lymph node involvement in patients undergoing liver resection for colorectal cancer metastases. Eur J Surg Oncol 2016; 43:322-329. [PMID: 28057391 DOI: 10.1016/j.ejso.2016.10.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/08/2016] [Accepted: 10/07/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While the indications for surgery among patients with colorectal cancer liver metastases (CRCLM) are expanding, the role of surgery in patients with hepatic lymph node involvement remains controversial. We report management and outcomes in a population-based cohort of patients undergoing hepatectomy with concomitant hepatic lymphadenectomy for CRCLM. METHODS All cases of hepatectomy for CRCLM in the Canadian Province of Ontario from 2002 to 2009 were identified using the population-based Ontario Cancer Registry and linked electronic records of treatment. Pathology reports were used to identify concomitant lymphadenectomy with liver resection as well as extent of disease and surgical procedure. RESULTS Among 1310 patients who underwent resection for CRCLM, 103 (8%) underwent simultaneous regional lymphadenectomy. Seventy-one percent of cases with lymphadenectomy (70/103) had a major liver resection (≥3 segments). Of the 103 lymphadenectomy cases, 80 (78%) were hepatic pedicle, 16 (16%) were celiac and 7 (7%) were para-aortic. The mean number of nodes removed was 2.2 (range 1-15). Ninety-day mortality was 6%. Twenty-nine percent (30/103) of cases had positive nodes. Unadjusted overall survival at 5 years for positive vs negative nodes was 21% vs 42% (p = 0.003); cancer-specific survival was 10% vs 43% (p < 0.001). In adjusted analyses, hepatic node involvement was associated with inferior OS (HR 2.19, p = 0.010) and CSS (HR 3.07, p = 0.002). CONCLUSIONS Patients with resected CRC liver metastases with regional lymph node involvement have inferior survival compared to patients with negative nodes. Despite this poor prognostic factor, a small proportion of cases with involved nodes will achieve long-term survival.
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Affiliation(s)
- S Nanji
- Department of Surgery, Queen's University, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada.
| | - M E Tsang
- Department of Surgery, St. Joseph's Hospital, Toronto, Ontario, Canada
| | - X Wei
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - C M Booth
- Department of Oncology, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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8
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Hadden WJ, de Reuver PR, Brown K, Mittal A, Samra JS, Hugh TJ. Resection of colorectal liver metastases and extra-hepatic disease: a systematic review and proportional meta-analysis of survival outcomes. HPB (Oxford) 2016; 18:209-20. [PMID: 27017160 PMCID: PMC4814625 DOI: 10.1016/j.hpb.2015.12.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/16/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) accounts for 9.7% of all cancers with 1.4 million new cases diagnosed each year. 19-31% of CRC patients develop colorectal liver metastases (CRLM), and 23-38% develop extra-hepatic disease (EHD). The aim of this systematic review was to determine overall survival (OS) in patients resected for CRLM and known EHD. METHODS A systematic review was undertaken to identify studies reporting OS after resection for CRLM in the presence of EHD. Proportional meta-analyses and relative risk of death before five years were assessed between patient groups. RESULTS A total of 15,144 patients with CRLM (2308 with EHD) from 52 studies were included. Three and 5-year OS were 58% and 26% for lung, 37% and 17% for peritoneum, and 35% and 15% for lymph nodes, respectively. The combined relative risk of death by five years was 1.49 (95% CI = 1.34-1.66) for lung, 1.59 (95% CI = 1.16-2.17) for peritoneal and 1.70 (95% CI = 1.57-1.84) for lymph node EHD, in favour of resection in the absence of EHD. CONCLUSION This review supports attempts at R0 resection in selected patients and rejects the notion that EHD is an absolute contraindication to resection.
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Affiliation(s)
- William J. Hadden
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Philip R. de Reuver
- Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Kai Brown
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia,Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Anubhav Mittal
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia,Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Jaswinder S. Samra
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia,Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Thomas J. Hugh
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia,Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia,Correspondence Thomas J. Hugh, Northern Upper GI Surgical Unit, Royal North Shore Hospital, St. Leonards NSW 2065, Australia. Tel: +61 2 9463 2899. Fax: +61 2 9463 2080.
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9
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Nichols SD, Albert S, Shirley L, Schmidt C, Abdel-Misih S, El-Dika S, Groce JR, Wu C, Goldberg RM, Bekaii-Saab T, Bloomston M. Outcomes in patients with obstructive jaundice from metastatic colorectal cancer and implications for management. J Gastrointest Surg 2014; 18:2186-91. [PMID: 25300799 PMCID: PMC4809042 DOI: 10.1007/s11605-014-2670-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/25/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Patients with metastatic colorectal cancer can develop jaundice from intrahepatic or extrahepatic causes. Currently, there is little data on the underlying causes and overall survival after onset of jaundice. The purpose of this study was to characterize the causes of jaundice and determine outcomes. METHODS Six hundred twenty-nine patients treated for metastatic colorectal cancer between 2004 and 2010 were retrospectively reviewed. Those developing jaundice were grouped as having intrahepatic or extrahepatic obstruction. Demographics, clinicopathologic, and outcome data were analyzed. RESULTS Sixty-two patients with metastatic colorectal cancer developed jaundice. Intrahepatic biliary obstruction was most common, occurring in younger patients. Time from metastatic diagnosis to presentation of jaundice was similar between groups, as was the mean number of prior lines of chemotherapy. Biliary decompression was successful 41.7 % of the time and was attempted more commonly for extrahepatic causes. Median overall survival after onset of jaundice was 1.5 months and it was similar between groups, but improved to 9.6 months in patients who were able to receive further chemotherapy. CONCLUSIONS Jaundice due to metastatic colorectal cancer is an ominous finding, representing aggressive tumor biology or exhaustion of therapies. Biliary decompression is often difficult and should only be pursued when additional treatment options are available.
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Affiliation(s)
- Shawnn D Nichols
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 410 West 10th Ave, N924 Doan Hall, Columbus, OH, 43210, USA
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10
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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.
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11
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Hwang M, Jayakrishnan TT, Green DE, George B, Thomas JP, Groeschl RT, Erickson B, Pappas SG, Gamblin TC, Turaga KK. Systematic review of outcomes of patients undergoing resection for colorectal liver metastases in the setting of extra hepatic disease. Eur J Cancer 2014; 50:1747-1757. [PMID: 24767470 DOI: 10.1016/j.ejca.2014.03.277] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 03/08/2014] [Accepted: 03/18/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Surgical resection for patients with colorectal liver metastases (CRLM) can offer patients a significant survival benefit. We hypothesised that patients with CRLM and extra hepatic disease (EHD) undergoing metastasectomy had comparable survival and describe outcomes based on the distribution of metastatic disease. METHODS A systematic search using a predefined registered protocol was undertaken between January 2003 and June 2012. Primary exposure was hepatic resection for CRLM and primary outcome measure was overall survival. Meta-regression techniques were used to analyse differences between patients with and without extra hepatic disease. FINDINGS From a pool of 4996 articles, 50 were retained for data extraction (3481 CRLM patients with EHD). The median survival (MS) was 30.5 (range, 9-98) months which was achieved with an operative mortality rate of 0-4.2%. The 3-year and 5-year overall survival (OS) were 42.4% (range, 20.6-77%) and 28% (range, 0-61%) respectively. Patients with EHD of the lungs had a MS of 45 (range, 39-98) months versus lymph nodes (portal and para-aortic) 26 (range, 21-48) months versus peritoneum 29 (range, 18-32) months. The MS also varied by the amount of liver disease - 42.2months (<two lesions) versus 39.6months (two lesions) versus 28months (⩾three lesions). INTERPRETATION In the evolving landscape of multimodality therapy, selective hepatic resection for CRLM patients with EHD is feasible with potential impact on survival. Patients with minimal liver disease and EHD in the lung achieve the best outcome.
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Affiliation(s)
- Michael Hwang
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Thejus T Jayakrishnan
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Danielle E Green
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ben George
- Division of Medical Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - James P Thomas
- Division of Medical Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ryan T Groeschl
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sam G Pappas
- Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, Maywood, IL, United States
| | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kiran K Turaga
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
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12
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Spolverato G, Ejaz A, Azad N, Pawlik TM. Surgery for colorectal liver metastases: The evolution of determining prognosis. World J Gastrointest Oncol 2013; 5:207-221. [PMID: 24363829 PMCID: PMC3868716 DOI: 10.4251/wjgo.v5.i12.207] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/05/2013] [Accepted: 11/16/2013] [Indexed: 02/05/2023] Open
Abstract
Despite improvements in the multi-modality treatment of colorectal liver metastasis (CRLM), survival after resection remains varied. Determining prognosis after surgical resection has historically been predicated on preoperative clinicopathological factors such as primary tumor stage, carcinoembryonic antigen levels, number of liver metastases, presence of extrahepatic disease, as well as other factors. While scoring systems have been developed by combining certain preoperative factors, these have been inconsistent in accurately determining prognosis. There has been increasing interest in the use of biologic and molecular markers to predict prognosis following CRLM. The role of markers such as KRAS, BRAF, p53, human telomerase reverse transcriptase, thymidylate synthase, Ki-67, and hypoxia inducible factor-1α and their correlation with accurately predicting survival after surgical resection have been supported by several studies. Furthermore, other elements such as pathological response to chemotherapy and the presence of circulating tumor cells have shown promise in accurately determining prognosis after resection for colorectal liver metastasis. We herein review past, present, and possible future markers of prognosis among colorectal cancer patients with liver metastasis undergoing resection with curative intent.
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13
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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]
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14
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Ramia JM, Figueras J, de la Plaza R, García-Parreño J. [Resection of liver metastases in patients with extrahepatic disease]. Cir Esp 2012; 90:483-9. [PMID: 22682358 DOI: 10.1016/j.ciresp.2012.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 11/22/2011] [Accepted: 01/05/2012] [Indexed: 02/07/2023]
Abstract
Patients who have liver metastasis and extrahepatic metastatic disease (EMD) have been considered as a patient subgroup with a very poor prognosis. Therefore, the presence of EMD was traditionally considered a contraindication for liver resection. But, survivals of around 30% at 5 years, and higher than that achieved with chemotherapy only obtained in some patients with liver metastasis of colorectal origin and EMD who had a resection performed on the hepatic and extrahepatic disease, obliges us to re-think what we must do in these patients. We have carried out an exhaustive review of the literature in an attempt to establish some working guidelines based on current scientific evidence. In summary, we can say that the presence of resectable EMD in patients with liver metastasis must not be considered as an absolute contraindication for liver resection, although the results are inferior to those obtained in patients without EMD. Patients with EMD localised in the ganglia of the coeliac trunk or aorto-cava have a short survival. The use of chemotherapy prior to the surgery is recommended to operate stable patients, or who respond to the chemotherapy and not in progression.
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Affiliation(s)
- José M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
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15
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López-Gómez M, Cejas P, Merino M, Fernández-Luengas D, Casado E, Feliu J. Management of colorectal cancer patients after resection of liver metastases: can we offer a tailored treatment? Clin Transl Oncol 2012; 14:641-58. [PMID: 22911546 DOI: 10.1007/s12094-012-0853-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 06/11/2012] [Indexed: 01/10/2023]
Abstract
Surgical resection remains the only option of cure for patients with colorectal liver metastases, and no patient should be precluded from surgery. There is much controversy not only regarding the most appropriate therapeutic approach in the neoadjuvant setting but also after surgery is performed. Many patients will experience early relapses but others will be long survivors. We need to establish reliable prognostic and predictive factors to offer a tailored treatment. Several prognostic factors after metastasectomy have been identified: high C-reactive protein levels, a high neutrophil-lymphocyte ratio, elevated neutrophil count and low serum albumin are related to a worst outcome. Elevated CEA and Ki 67 levels, intrahepatic and perihepatic lymph node invasion are also some of the markers related to a worst outcome. In contrast, the administration of preoperative chemotherapy has been associated with a better prognosis after hepatectomy. The administration of adjuvant chemotherapy should be done taking in consideration these factors. Regarding predictive factors, determination of ERCC1, TS, TP and DPD and UGT1 polymorphisms assessment could be considered prior to chemotherapy administration. This would avoid treatment related toxicities and increase this population quality of life.
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Affiliation(s)
- Miriam López-Gómez
- Clinical Oncology Department, Infanta Sofía University Hospital, Paseo de Europa 34, San Sebastián de los Reyes, 28702, Madrid, Spain.
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16
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The role of liver resection for colorectal cancer metastases in an era of multimodality treatment: A systematic review. Surgery 2012; 151:860-70. [DOI: 10.1016/j.surg.2011.12.018] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 12/22/2011] [Indexed: 12/14/2022]
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17
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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]
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18
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Viana EF, Herman P, Coelho FF, Taka TA, D'Albuquerque LAC, Cecconello I. The role of hilar lymphadenectomy in patients subjected to hepatectomy due to colorectal metastasis. ARQUIVOS DE GASTROENTEROLOGIA 2012; 48:217-9. [PMID: 21952709 DOI: 10.1590/s0004-28032011000300012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 08/13/2010] [Indexed: 11/22/2022]
Abstract
CONTEXT Hepatectomy is the treatment of choice for colorectal liver metastases, and several studies have shown good results, with 5-year survival rates ranging from 40% to 57%. Several clinical and pathological predictive factors for survival after liver resection have been studied. Involvement of the hepatic hilum lymph nodes, the incidence of which varies from 2% to 10%, indicates a poor long-term prognosis. RESULTS Despite variable results, some authors have reported a not-insignificant improvement in survival rate in liver-metastasis patients with hilar lymph node involvement who undergo combined liver resection and lymphadenectomy. Due to the low rates of morbidity and mortality for liver-resection surgery, several specialized centers perform liver resections combined with lymphadenectomies in selected cases. It should be noted that the therapeutic value of systemic lymphadenectomy is not yet entirely understood, and only controlled studies comparing groups with and without lymphadenectomy can fully resolve the issue. CONCLUSION In any case, hilar lymph node dissection has been shown to be a useful tool for improving the accuracy of extra hepatic disease staging, regardless of its impact on survival.
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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.
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Affiliation(s)
- Reinhart T Grundmann
- Reinhart T Grundmann, Kreiskliniken Altötting-Burghausen, In den Grüben 144, D-84489 Burghausen, Germany
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Rau C, Blanc B, Ronot M, Dokmak S, Aussilhou B, Faivre S, Vilgrain V, Paradis V, Belghiti J. Neither preoperative computed tomography nor intra-operative examination can predict metastatic lymph node in the hepatic pedicle in patients with colorectal liver metastasis. Ann Surg Oncol 2011; 19:163-8. [PMID: 21837526 DOI: 10.1245/s10434-011-1994-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND In patients operated on for colorectal liver metastasis (CRLM), metastatic lymph node (LN) of the hepatic pedicle is a major prognostic factor. Efficiency of preoperative computed tomography (CT) and intraoperative examination for the diagnosis of metastatic LN of hepatic pedicle is prospectively evaluated. METHODS From January 2008 to June 2010, 76 patients underwent liver resection for CRLM, with systematic LN pedicle dissection. Preoperative CT scan evaluated prospectively location, size, and aspect of LN, whereas the surgeon assessed size and consistency of LN Results of CT and intraoperative findings were compared with pathologic findings to determine sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). RESULTS A total of 241 nodes were analyzed (3.2 ± 2.1 LN per patient). Systematic LN dissection increased the operative time by a mean of 20 ± 12.5 min, without any specific morbidity or mortality related to the LN clearance. Metastatic LN in the hepatic pedicle was observed in 15 (20%) patients and were unrelated to the number, size, and location of CRLM. NPV and PPV of the preoperative CT scan was 85 and 56%, respectively. Intraoperative evaluation of LN had a high NPV of 91% with a low PPV of 43%. Even with the combination of CT and intraoperative evaluation, 27% of the patients with a pathological metastatic LN were not suspected. CONCLUSIONS Because neither the preoperative CT nor the surgical evaluation accurately predicts metastatic LN in the hepatic pedicle, accurate oncological staging require a systematic pedicular LN clearance during liver resection for CRLM.
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Affiliation(s)
- Cédric Rau
- Department of HPB Surgery, Beaujon Hospital, Clichy, France
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21
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Ueno S, Sakoda M, Kitazono M, Iino S, Kurahara H, Minami K, Ando K, Mataki Y, Maemura K, Ishigami S, Natsugoe S. Is Delayed Liver Resection Appropriate for Patients with Metachronous Colorectal Metastases? Ann Surg Oncol 2011; 18:1104-1109. [DOI: 10.1245/s10434-010-1418-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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22
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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]
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23
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Viana EF, Herman P, Siqueira SC, Taka T, Carvalho P, Coelho FF, Pugliese V, Saad WA, D'Albuquerque LAC. Lymphadenectomy in colorectal cancer liver metastases resection: incidence of hilar lymph nodes micrometastasis. J Surg Oncol 2009; 100:534-7. [PMID: 19653249 DOI: 10.1002/jso.21357] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Liver resection is considered the best treatment for metastatic colorectal cancer. Several prognostic factors have been investigated, and many studies have shown that hepatic hilum lymph nodes involvement has a negative impact on prognosis. The present study evaluated the frequency of microscopic involvement of hilar lymph nodes, through systematic lymphadenectomy and analysis of micrometastases in patients undergoing hepatectomy due to colorectal metastasis. METHODS A total of 28 patients underwent hepatic resection with hilar lymphadenectomy. Lymph nodes considered negative by conventional hematoxylin and eosin (H&E) staining were analyzed by serial sectioning with 100-microm intervals and immunohistochemistry (IHC) with anti-human pancytokeratin antibody AE1/AE3. RESULTS In average, 6.18 lymph nodes were dissected per patient. No morbidity or mortality was associated to lymphadenectomy. In two patients, conventional H&E analysis showed presence of microscopic lymph node metastasis. IHC analysis allowed the identification of three other patients with lymph node micrometastases. The overall frequency of microscopic metastases, including micrometastasis, was 18%. CONCLUSIONS Systematic lymphadenectomy allowed the detection of microscopic lymph node metastases, resulting in more accurate staging of extrahepatic disease. The inclusion of IHC increased the detection of lymph node micrometastasis.
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Affiliation(s)
- E F Viana
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil
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24
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Natural history of patients with subcentimeter pulmonary nodules undergoing hepatic resection for metastatic colorectal cancer. J Am Coll Surg 2009; 210:31-8. [PMID: 20123329 DOI: 10.1016/j.jamcollsurg.2009.09.032] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 09/11/2009] [Accepted: 09/22/2009] [Indexed: 12/22/2022]
Abstract
BACKGROUND CT imaging frequently detects subcentimeter pulmonary nodules (SPN) in patients undergoing resection of colorectal cancer liver metastases. Their clinical significance is unknown. STUDY DESIGN Patients were identified who underwent hepatic resection for colorectal cancer liver metastases between October 2004 and March 2006. The presence and imaging features of preoperative SPN were analyzed for their association with progression-free survival (PFS), disease-specific survival (DSS), and SPN progression. RESULTS One hundred sixty patients underwent liver resection and 68 (43%) had SPN identified preoperatively. Median number of nodules was 1 (75(th) percentile: </=2 nodules) and median size of the largest was 3 mm (25(th) to 75(th) percentile: 2 to 5 mm). SPN were unilateral in 77%, calcified in 19%, solid in 92%, and smooth in contour in 95% of patients. At median follow-up of 31 months for survivors, SPN were proven to be metastatic disease in 35% of patients (24 of 68), either by radiographic increase in size or number (n = 12) or histologic confirmation after resection (n = 12). Median PFS for the 160 patients was 16 months and 3-year DSS was 78%. There was a trend toward shorter median PFS in patients with preoperative SPN compared with patients with no SPN (12 versus 20 months; p = 0.242). There was no difference in 3-year DSS (70% versus 83%; p = 0.46). SPN progression after hepatic resection did not substantially affect 3-year DSS. Calcified nodules were less likely to progress compared with noncalcified nodules (8% versus 42%; p = 0.03). CONCLUSION SPN are common among patients undergoing resection of colorectal cancer liver metastases and approximately one-third of these will prove to be metastatic disease. Presence of limited preoperative SPN might be associated with shorter PFS after hepatectomy, but does not substantially impact 3-year DSS, and should not necessarily preclude resection of hepatic metastases.
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Carpizo DR, D'Angelica M. Liver resection for metastatic colorectal cancer in the presence of extrahepatic disease. Lancet Oncol 2009; 10:801-9. [PMID: 19647200 DOI: 10.1016/s1470-2045(09)70081-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Early studies of liver resection for colorectal cancer metastases identified patients with concomitant extrahepatic disease as a group with poor outcomes. These studies concluded that the presence of extrahepatic disease should be a contraindication to resection. This contraindication has more recently been challenged. In this paper, we review the published work on metastatic colorectal cancer, pertaining to the role of surgery in patients with liver metastases and concomitant extrahepatic disease. 5-year survival after resection is worse in patients with extrahepatic disease than in patients with liver-only disease, but is similar to that seen in patients who underwent resection in the era before the use of modern chemotherapy. Recurrence occurs in most patients. There is a role for surgery in highly selected patients with single sites of extrahepatic disease, although expectations should be different than those of patients with liver-only metastases. Further studies are necessary to define the patient group best suited for resection of hepatic metastases with extrahepatic disease.
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Affiliation(s)
- Darren R Carpizo
- Division of Surgical Oncology, The Cancer Institute of New Jersey, Robert Wood-Johnson University Medical School, New Brunswick, NJ, USA
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Carpizo DR, D’Angelica M. Liver Resection for Metastatic Colorectal Cancer in the Presence of Extrahepatic Disease. Ann Surg Oncol 2009; 16:2411-21. [DOI: 10.1245/s10434-009-0493-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Accepted: 02/23/2009] [Indexed: 12/13/2022]
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Schmidt CR, Jarnagin WR. In Reply: Partial Hepatectomy for Colorectal Metastases and Perihepatic Lymph Node Micrometastases. Ann Surg Oncol 2008. [DOI: 10.1245/s10434-008-0028-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Garcea G, Ong SL, Maddern GJ. Inoperable colorectal liver metastases: a declining entity? Eur J Cancer 2008; 44:2555-72. [PMID: 18755585 DOI: 10.1016/j.ejca.2008.07.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 07/14/2008] [Accepted: 07/17/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND Untreated colorectal liver metastases (CLMs) have a dismal prognosis. Surgery remains the gold standard of treatment, but many patients will have inoperable disease at presentation. Until recently, the outlook for such patients was bleak. The purpose of this review was to report on available options in the treatment CLMs, which would be considered unresectable by conventional evaluation. METHODS Inclusion criteria were articles published in English-language journals reporting on either retrospective or prospective cohorts of patients undergoing treatment for conventionally inoperable CLM. Main outcome measures were survival, resectability rates, morbidity and mortality following treatment of the patients' disease. RESULTS Improved chemotherapy regimes and other innovative treatments have opened up new options for such patients and may even render conventionally inoperable disease resectable. The aim of treatment should be down-staging of metastases to achieve resectability, however, other treatments such as ablation may be also be used (either alone or in conjunction with resection). CONCLUSION A nihilistic attitude to the patient with seemingly inoperable liver metastases should be discouraged. Discussion of such patients at multi-disciplinary meetings is essential in order to plan and monitor treatments.
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Affiliation(s)
- G Garcea
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, The Queen Elizabeth Hospital, Adelaide, SA, Australia.
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Pandey D. Biological behavior of perihepatic lymph node metastasis and its impact on prognosis following liver resection for colorectal metastases. Ann Surg Oncol 2008; 15:2620; author reply 2621. [PMID: 18425552 DOI: 10.1245/s10434-008-9919-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 03/26/2008] [Indexed: 11/18/2022]
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