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Karaoğlan BB, Öz DK, Araz MS, Akyol C, Utkan G. Advancements in the Management of Synchronous Colorectal Liver Metastases: A Comprehensive Review of Surgical, Systemic, and Local Treatment Modalities. Curr Oncol Rep 2024; 26:791-803. [PMID: 38776011 PMCID: PMC11224077 DOI: 10.1007/s11912-024-01548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE OF REVIEW This review addresses the current landscape of colorectal cancer (CRC) with a focus on liver metastases, the third most common cancer globally. It explores recent findings in treatment strategies, emphasizing the dynamic interplay between surgery, systemic chemotherapy, and local therapies for synchronous colorectal liver metastases (CRLMs). RECENT FINDINGS Highlighting the role of advanced imaging, the review underscores the significance of contrast-enhanced MRI in surgical planning for CRLMs. Surgical resection remains a primary choice for resectable cases, with considerations for oncologic scoring systems and tumor biology. Perioperative systemic chemotherapy plays a pivotal role, especially in conversion therapy for initially unresectable CRLMs. The review also explores various local therapies, including radiofrequency ablation, microwave ablation, stereotactic body radiotherapy, hepatic arterial infusional chemotherapy, selective internal radiation therapy, and transarterial chemoembolization for unresectable cases. A comprehensive approach, integrating surgery, systemic chemotherapy, and local therapies, is crucial for managing synchronous CRLMs. Surgical resection and perioperative chemotherapy are key players, guided by considerations of tumor biology and scoring systems. For unresectable cases, local therapies offer viable alternatives, emphasizing the need for tailored treatments. Multidisciplinary collaboration among medical oncologists, surgeons, and radiologists is essential. Ongoing research will refine treatment approaches, while emerging technologies hold promise for further advancements in managing colorectal liver metastases.
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Affiliation(s)
- Beliz Bahar Karaoğlan
- Department of Medical Oncology, Faculty of Medicine, Ankara University, 06100, Ankara, Turkey.
| | - Diğdem Kuru Öz
- Department of Radiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Mine Soylu Araz
- Department of Nuclear Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Cihangir Akyol
- Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Güngör Utkan
- Department of Medical Oncology, Faculty of Medicine, Ankara University, 06100, Ankara, Turkey
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Wach MM, Washburn LA, Alvikas J, Qu LT, Zhang M, Etherington MS, Rieser C, Haykal T, Pingpank JF, Zureikat AH, Geller DA, Hoehn RS, Tohme S. Combined hepatic resection and ablation for high burden of colorectal liver metastases demonstrates safety and durable survival. HPB (Oxford) 2024; 26:362-369. [PMID: 38008683 DOI: 10.1016/j.hpb.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/15/2023] [Accepted: 11/03/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Hepatic resection (HR) and thermal ablation of Colorectal Liver Metastases (CRLM) have each individually demonstrated safety and survival benefit. We sought to provide our experience with the combination of HR + ablation within one operation for patients with multiple CRLM. METHODS Review of a single institution database of patients who underwent HR + ablation between 2010 and 2019. RESULTS 161 patients were identified who underwent HR + ablation for isolated CRLM (mean age: 59, male 63.4%). 125 (77.6%) patients had bilobar disease and 92 (57.1%) patients had ≥5 tumors. 28 (17.4%) patients experienced minor (grade 1 or 2) complications while 20 (12.4%) had grade 3-5 complications. Patients who underwent simultaneous colon resection with HR + ablation had a higher complication rate (22 of 47, 46.8%) than those undergoing HR + ablation only (26 of 114, 22.8%, p = 0.002). Median and 5-year OS for all patients undergoing HR + ablation was 38.2 months and 33.2%, respectively. 5-year hepatic recurrence free survival was 23.5%. Patients with 5 or more tumors demonstrated no difference in median survival compared to those with fewer than 5 tumors (37.0 months vs 38.4 months, p = 0.326). CONCLUSIONS In this population of CRLM patients with a relatively high burden of disease, HR + ablation demonstrated an acceptable safety profile as well as durable long-term survival.
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Affiliation(s)
- Michael M Wach
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laura A Washburn
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jurgis Alvikas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Linda T Qu
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michelle Zhang
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mark S Etherington
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Caroline Rieser
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tony Haykal
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James F Pingpank
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Amer H Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David A Geller
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Richard S Hoehn
- Department of Surgery, University Hospitals, Cleveland, OH, USA
| | - Samer Tohme
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Marcinak CT, Schwartz PB, Basree MM, Hurst N, Bassetti M, Kratz JD, Uboha NV. Treatment of Oligometastatic GI Cancers. Am Soc Clin Oncol Educ Book 2024; 44:e430152. [PMID: 38190577 DOI: 10.1200/edbk_430152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Oligometastatic state is believed to potentially represent a transitional stage between early, locoregional state disease and widely metastatic disease. Historically, locoregional approaches, particularly in advanced colorectal cancers, have demonstrated efficacy in select patients with limited burden of metastatic disease. Recent strides in systemic therapies, including biomarker-based treatments and immunotherapy, alongside innovations in surgical techniques and novel locoregional approaches such as stereotactic radiotherapy and ablation, have ushered in a new era of therapeutic possibilities across all oligometastatic GI cancers. Despite these advancements, there remains a significant gap in high-quality prospective evidence guiding patient selection and treatment decisions across various disease types. Ongoing clinical trials are anticipated to provide crucial insights into oligometastatic states, fostering the refinement of disease-specific oligometastatic state definitions and treatment algorithms. This article reviews existing data on the management of oligometastatic GI cancer, summarizes current state of knowledge for each disease state, and provides updates on ongoing studies in this space.
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Affiliation(s)
- Clayton T Marcinak
- Department of Surgery, University of Wisconsin School of Medicine and Public Health University of Wisconsin-Madison, Madison, WI
| | - Patrick B Schwartz
- Department of Surgery, University of Wisconsin School of Medicine and Public Health University of Wisconsin-Madison, Madison, WI
| | - Mustafa M Basree
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Newton Hurst
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Michael Bassetti
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Jeremy D Kratz
- University of Wisconsin-Madison, Madison, WI
- University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI
- Center for Human Genomics and Precision Medicine, University of Wisconsin, Madison, WI
- William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Nataliya V Uboha
- University of Wisconsin-Madison, Madison, WI
- University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI
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Yokoi R, Tajima JY, Fukada M, Hayashi H, Kuno M, Asai R, Sato Y, Yasufuku I, Kiyama S, Tanaka Y, Murase K, Matsuhashi N. Optimizing Treatment Strategy for Oligometastases/Oligo-Recurrence of Colorectal Cancer. Cancers (Basel) 2023; 16:142. [PMID: 38201569 PMCID: PMC10777959 DOI: 10.3390/cancers16010142] [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: 11/28/2023] [Revised: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer, and nearly half of CRC patients experience metastases. Oligometastatic CRC represents a distinct clinical state characterized by limited metastatic involvement, demonstrating a less aggressive nature and potentially improved survival with multidisciplinary treatment. However, the varied clinical scenarios giving rise to oligometastases necessitate a precise definition, considering primary tumor status and oncological factors, to optimize treatment strategies. This review delineates the concepts of oligometastatic CRC, encompassing oligo-recurrence, where the primary tumor is under control, resulting in a more favorable prognosis. A comprehensive examination of multidisciplinary treatment with local treatments and systemic therapy is provided. The overarching objective in managing oligometastatic CRC is the complete eradication of metastases, offering prospects of a cure. Essential to this management approach are local treatments, with surgical resection serving as the standard of care. Percutaneous ablation and stereotactic body radiotherapy present less invasive alternatives for lesions unsuitable for surgery, demonstrating efficacy in select cases. Perioperative systemic therapy, aiming to control micrometastatic disease and enhance local treatment effectiveness, has shown improvements in progression-free survival through clinical trials. However, the extension of overall survival remains variable. The review emphasizes the need for further prospective trials to establish a cohesive definition and an optimized treatment strategy for oligometastatic CRC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City 501-1194, Gifu, Japan; (R.Y.); (K.M.)
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Takei D, Kuroda S, Kobayashi T, Mashima H, Tahara H, Ohira M, Aikata H, Chosa K, Baba Y, Ohdan H. Prospective Exploratory Phase I Clinical Trial Assessing the Safety of Preoperative Marking for Small Liver Tumors. Cureus 2023; 15:e50603. [PMID: 38226110 PMCID: PMC10788183 DOI: 10.7759/cureus.50603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Background Small tumors in liver cirrhosis are difficult to distinguish using intraoperative ultrasonography. In addition, preoperative chemotherapy for metastatic liver cancer may diminish tumor size, thus making tumors difficult to identify intraoperatively. To address such difficulties, we devised a method to mark liver tumors preoperatively to facilitate intraoperative identification. This study aimed to investigate the safety of a preoperative liver tumor marking method. Methodology This exploratory prospective clinical trial included patients with liver tumors measuring ≤20 mm requiring resection. Preoperative marking was performed by placing a coil for embolization of blood vessels near the tumor using either the transcatheter or percutaneous approach. The tumor was identified and resected by intraoperative ultrasonography based on the marker. The study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000028608). Results Overall, 19 patients (9 with primary liver cancer and 10 with metastatic tumors) were recruited. The transcatheter and percutaneous methods were used in 13 and 6 patients, respectively. Marking was not possible in two patients in the transcatheter group because the catheter could not be guided to the vicinity of the tumor. There were no marking-related complications. Hepatectomy was performed in all but one patient who was not fit for hepatectomy owing to the development of a metastatic liver tumor. The markers were adequately identified during hepatectomy. Additionally, there were no difficulties in the surgical procedure or postoperative complications. Conclusions Preoperative marking with embolization coils can be performed safely for intraoperative identification of liver nodules.
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Affiliation(s)
- Daisuke Takei
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shintaro Kuroda
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Hiroaki Mashima
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Hiroyuki Tahara
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Hiroshi Aikata
- Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, JPN
| | - Keigo Chosa
- Department of Diagnostic Radiology, Hiroshima University, Hiroshima, JPN
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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Simsek M, Besiroglu M, Akcakaya A, Topcu A, Yasin AI, Isleyen ZS, Seker M, Turk HM. Local interventions for colorectal cancer metastases to liver and lung. Ir J Med Sci 2023; 192:2635-2641. [PMID: 36929352 DOI: 10.1007/s11845-023-03340-7] [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: 01/08/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Colorectal cancer is a common cause of cancer-related deaths. About 1/3 of all cases present with distant metastasis, with the liver as the leading site and the lung as the most common extra-abdominal site. AIMS It was aimed to evaluate the clinical characteristics and the outcomes of colorectal cancer patients with liver or lung metastasis who had received local treatments. METHODS This is a retrospective, cross-sectional, and descriptive study. The study was performed with colorectal cancer patients that referred to the medical oncology clinic of a university hospital between December 2013 and August 2021. RESULTS A total number of 122 patients who have received local treatments were included. Radiofrequency ablation was applied in 32 patients (26.2%), metastasis was surgically resected in 84 patients (68.9%), and stereotactic body radiotherapy was preferred in six patients (4.9%). At the first follow-up control after completion of local or multimodal treatment, no residual tumor was determined with radiological assessment in 88 patients (72.1%). The median progression-free survival (16.7 months vs 9.7 months) (p = .000) and the median overall survival (37.3 months vs 25.5 months) (p = .004) of these patients were significantly better than the patients with residual disease. CONCLUSIONS Local interventions that are applied to highly selected patients may improve the survival of metastatic colorectal cancer patients. A close follow-up after local therapies is important to diagnose recurrent disease because repeated local interventions may be possible to achieve better outcomes.
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Affiliation(s)
- Melih Simsek
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey.
| | - Mehmet Besiroglu
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Adem Akcakaya
- Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Atakan Topcu
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ayse Irem Yasin
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Zehra Sucuoglu Isleyen
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Mesut Seker
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Haci Mehmet Turk
- Department of Internal Medicine, Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
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Granata V, Fusco R, De Muzio F, Brunese MC, Setola SV, Ottaiano A, Cardone C, Avallone A, Patrone R, Pradella S, Miele V, Tatangelo F, Cutolo C, Maggialetti N, Caruso D, Izzo F, Petrillo A. Radiomics and machine learning analysis by computed tomography and magnetic resonance imaging in colorectal liver metastases prognostic assessment. LA RADIOLOGIA MEDICA 2023; 128:1310-1332. [PMID: 37697033 DOI: 10.1007/s11547-023-01710-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE The aim of this study was the evaluation radiomics analysis efficacy performed using computed tomography (CT) and magnetic resonance imaging in the prediction of colorectal liver metastases patterns linked to patient prognosis: tumor growth front; grade; tumor budding; mucinous type. Moreover, the prediction of liver recurrence was also evaluated. METHODS The retrospective study included an internal and validation dataset; the first was composed by 119 liver metastases from 49 patients while the second consisted to 28 patients with single lesion. Radiomic features were extracted using PyRadiomics. Univariate and multivariate approaches including machine learning algorithms were employed. RESULTS The best predictor to identify tumor growth was the Wavelet_HLH_glcm_MaximumProbability with an accuracy of 84% and to detect recurrence the best predictor was wavelet_HLH_ngtdm_Complexity with an accuracy of 90%, both extracted by T1-weigthed arterial phase sequence. The best predictor to detect tumor budding was the wavelet_LLH_glcm_Imc1 with an accuracy of 88% and to identify mucinous type was wavelet_LLH_glcm_JointEntropy with an accuracy of 92%, both calculated on T2-weigthed sequence. An increase statistically significant of accuracy (90%) was obtained using a linear weighted combination of 15 predictors extracted by T2-weigthed images to detect tumor front growth. An increase statistically significant of accuracy at 93% was obtained using a linear weighted combination of 11 predictors by the T1-weigthed arterial phase sequence to classify tumor budding. An increase statistically significant of accuracy at 97% was obtained using a linear weighted combination of 16 predictors extracted on CT to detect recurrence. An increase statistically significant of accuracy was obtained in the tumor budding identification considering a K-nearest neighbors and the 11 significant features extracted T1-weigthed arterial phase sequence. CONCLUSIONS The results confirmed the Radiomics capacity to recognize clinical and histopathological prognostic features that should influence the choice of treatments in colorectal liver metastases patients to obtain a more personalized therapy.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.
| | | | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100, Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100, Campobasso, Italy
| | - Sergio Venanzio Setola
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Alessandro Ottaiano
- Clinical Experimental Abdominal Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80131, Naples, Italy
| | - Claudia Cardone
- Clinical Experimental Abdominal Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80131, Naples, Italy
| | - Antonio Avallone
- Clinical Experimental Abdominal Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80131, Naples, Italy
| | - Renato Patrone
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131, Naples, Italy
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
- SIRM Foundation, Italian Society of Medical and Interventional Radiology (SIRM), 20122, Milan, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
- SIRM Foundation, Italian Society of Medical and Interventional Radiology (SIRM), 20122, Milan, Italy
| | - Fabiana Tatangelo
- Division of Pathological Anatomy and Cytopathology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131, Naples, Italy
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084, Salerno, Italy
| | - Nicola Maggialetti
- Department of Medical Science, Neuroscience and Sensory Organs (DSMBNOS), University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Radiology Unit-Sant'Andrea University Hospital, Sapienza-University of Rome, 00189, Rome, Italy
| | - Francesco Izzo
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131, Naples, Italy
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
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Fernández Montes A, Alonso V, Aranda E, Élez E, García Alfonso P, Grávalos C, Maurel J, Vera R, Vidal R, Aparicio J. SEOM-GEMCAD-TTD clinical guidelines for the systemic treatment of metastatic colorectal cancer (2022). Clin Transl Oncol 2023; 25:2718-2731. [PMID: 37133732 PMCID: PMC10425293 DOI: 10.1007/s12094-023-03199-1] [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: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/04/2023]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer deaths in Spain. Metastatic disease is present in 15-30% of patients at diagnosis and up to 20-50% of those with initially localized disease eventually develop metastases. Recent scientific knowledge acknowledges that this is a clinically and biologically heterogeneous disease. As treatment options increase, prognosis for individuals with metastatic disease has steadily improved over recent decades. Disease management should be discussed among experienced, multidisciplinary teams to select the most appropriate systemic treatment (chemotherapy and targeted agents) and to integrate surgical or ablative procedures, when indicated. Clinical presentation, tumor sidedness, molecular profile, disease extension, comorbidities, and patient preferences are key factors when designing a customized treatment plan. These guidelines seek to provide succinct recommendations for managing metastatic CRC.
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Affiliation(s)
- Ana Fernández Montes
- Medical Oncology Department, Complexo Hospitalario Universitario, Ourense (CHUO), C/ Ramón Puga, 56, 32005 Ourense, Spain
| | - Vicente Alonso
- Medical Oncology Department, Hospital Universitario Miguel Servet, Saragossa, Spain
| | - Enrique Aranda
- Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Elena Élez
- Medical Oncology Department, Hospital Universitario Vall D’Hebron, Barcelona, Spain
| | - Pilar García Alfonso
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Grávalos
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Joan Maurel
- Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Ruth Vera
- Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Rosario Vidal
- Medical Oncology Department, Complejo Asistencial Universitario, Salamanca, Spain
| | - Jorge Aparicio
- Medical Oncology Department, Hospital Universitari I Politècnic la Fe, Valencia, Spain
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Nagarajan G, Doshi P, Bardeskar NS, Kulkarni A, Punamiya A, Tongaonkar H. Association between sarcopenia and postoperative complications in patients undergoing surgery for gastrointestinal or hepato-pancreatico-biliary cancer. J Surg Oncol 2023; 128:682-691. [PMID: 37183521 DOI: 10.1002/jso.27315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/02/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite surgical advances, postoperative complications persist, affecting oncologic outcomes and increasing treatment costs. It is important to identify a marker that can predict postoperative complications, which can help prehabilitate patients before surgery. This study evaluated sarcopenia as a predictive marker of postoperative complications in patients undergoing surgery for gastrointestinal (GI) or hepato-pancreatico-biliary (HPB) cancer. METHODS Sarcopenia was assessed using the skeletal muscle index at the third lumbar vertebra on abdominal computed tomography. The predictive ability of sarcopenia was evaluated by adjusting for other clinicopathological factors. RESULTS Of the 210 patients, 81 (38.57%) were sarcopenic. The overall morbidity and mortality were 33.81% and 2.86%, respectively. Major complications (Clavien-Dindo Grade ≥ III) were observed in 10.95% patients and sarcopenic patients were significantly more likely to develop major complications (p = 1.42 × 10-10 ). Sarcopenia (p = 6.13 × 10-6 ; odds ratio = 12.29) independently predicted postoperative complications and prolonged hospital stay (p = 0.01). CONCLUSION Sarcopenia objectively predicted the development of postoperative complications and prolonged hospital stay in patients undergoing surgery for GI or HPB cancer. This may facilitate the prehabilitation of patients planned for surgery to reduce the risk of complications.
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Affiliation(s)
- Ganesh Nagarajan
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, India
| | - Pratik Doshi
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Nikhil S Bardeskar
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, India
| | - Aniruddha Kulkarni
- Department of Interventional Radiology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Aditya Punamiya
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Hemant Tongaonkar
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
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Lorton O, Guillemin PC, Peloso A, M’Rad Y, Crowe LA, Koessler T, Poletti PA, Boudabbous S, Ricoeur A, Salomir R. In Vivo Thermal Ablation of Deep Intrahepatic Targets Using a Super-Convergent MRgHIFU Applicator and a Pseudo-Tumor Model. Cancers (Basel) 2023; 15:3961. [PMID: 37568777 PMCID: PMC10417404 DOI: 10.3390/cancers15153961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND HIFU ablation of liver malignancies is particularly challenging due to respiratory motion, high tissue perfusion and the presence of the rib cage. Based on our previous development of a super-convergent phased-array transducer, we aimed to further investigate, in vivo, its applicability to deep intrahepatic targets. METHODS In a series of six pigs, a pseudo-tumor model was used as target, visible both on intra-operatory MRI and post-mortem gross pathology. The transcostal MRgHIFU ablation was prescribed coplanar with the pseudo-tumor, either axial or sagittal, but deliberately shifted 7 to 18 mm to the side. No specific means of protection of the ribs were implemented. Post-treatment MRI follow-up was performed at D7, followed by animal necropsy and gross pathology of the liver. RESULTS The pseudo-tumor was clearly identified on T1w MR imaging and subsequently allowed the MRgHIFU planning. The peak temperature at the focal point ranged from 58-87 °C. Gross pathology confirmed the presence of the pseudo-tumor and the well-delineated MRgHIFU ablation at the expected locations. CONCLUSIONS The specific design of the transducer enabled a reliable workflow. It demonstrated a good safety profile for in vivo transcostal MRgHIFU ablation of deep-liver targets, graded as challenging for standard surgery.
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Affiliation(s)
- Orane Lorton
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Pauline Coralie Guillemin
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Andrea Peloso
- Visceral Surgery Division, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Yacine M’Rad
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | | | - Thibaud Koessler
- Oncology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | | | - Sana Boudabbous
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Alexis Ricoeur
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Rares Salomir
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, 1205 Geneva, Switzerland
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11
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Dumarco RB, Fonseca GM, Coelho FF, Jeismann VB, Makdissi FF, Kruger JAP, Nahas SC, Herman P. Multiple colorectal liver metastases resection can offer long-term survival: The concept of a chronic neoplastic disease. Surgery 2023; 173:983-990. [PMID: 36220666 DOI: 10.1016/j.surg.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Resection for colorectal liver metastases has evolved significantly and, currently, there are no limits to the number of resected nodules. This study aimed to evaluate the outcomes and prognostic factors after liver resection for patients with ≥4 colorectal liver metastases, emphasizing long-term survival. METHODS The study population consisted of 137 patients with ≥4 colorectal liver metastases out of a total of 597 patients with colorectal liver metastases who underwent curative intent liver resection from January 2010 to July 2019 in a single hepatobiliary center. RESULTS The probability of overall and disease-free survival at 1, 3, and 5 years was 90.8%, 64.5%, 40.6%, and 37.7%, 19.3%, 18.1%, respectively. In a multivariate analysis for overall survival, the size of the largest metastatic nodule was the only unfavorable factor (P = .001). For disease-free survival, complete pathological response was a favorable factor (P = .04), and the following were negative factors: number of nodules ≥7 (P = .034), radiofrequency ablation during surgery (P = .04), positive primary tumor lymph nodes (P = .034), R1 resection (P = .011), and preoperative carcinoembryonic antigen >20 ng/mL (P = .015). After the first and second years of follow-up, 59 patients (45.3%) and 45 patients (34.6%), respectively, were not receiving chemotherapy. After 5 years of follow-up, 21 (16.1%) multimetastatic patients were chemotherapy-free. CONCLUSION A significant number of patients with multiple colorectal liver metastases will present long-term survival and should not be denied surgery. The long-term survival rates, even in the presence of recurrence, characterize a chronic neoplastic disease.
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Affiliation(s)
- Rodrigo Blanco Dumarco
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil
| | - Gilton Marques Fonseca
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil. https://twitter.com/medgilton
| | - Fabricio Ferreira Coelho
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil
| | - Vagner Birk Jeismann
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil. https://twitter.com/vjeismann
| | - Fabio Ferrari Makdissi
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil
| | - Jaime Arthur Pirolla Kruger
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil
| | - Sergio Carlos Nahas
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil. https://twitter.com/SergioNahasDr
| | - Paulo Herman
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil.
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12
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Papaconstantinou D, Pararas N, Pikouli A, Nastos C, Charalampopoulos A, Dellaportas D, Bagias G, Pikoulis E. Precision Surgery of Colorectal Liver Metastases in the Current Era: A Systematic Review. Cancers (Basel) 2023; 15:cancers15072083. [PMID: 37046744 PMCID: PMC10093504 DOI: 10.3390/cancers15072083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
Abstract
Liver resection for colorectal liver metastases (CRLM) is widely considered the treatment with the highest curative potential. However, not all patients derive the same oncological benefit, underlining the need for better patient stratification and treatment allocation. In this context, we performed a systematic review of the literature to determine the role of RAS status in selecting the optimal surgical strategy. Evidence comparing anatomical with non-anatomical resections depending on RAS mutational status was scarce and conflicting, with two studies reporting superiority in mutated RAS (mutRAS) patients and two studies reporting equivalent outcomes. The rate of incomplete microscopic resection (R1) was found to be increased among mutRAS patients, possibly due to higher micrometastatic spread lateral to the primary lesion. The impact of R1 resection margins was evaluated separately for mutRAS and wild-type patients in three studies, of which, two indicated an additive detriment to long-term survival in the former group. In the current era of precision surgery, RAS status can be utilized to predict the efficacy of liver resection in the treatment of CRLM, avoiding a potentially morbid operation in patients with adverse tumor profiles.
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13
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Granata V, Fusco R, Setola SV, Galdiero R, Maggialetti N, Patrone R, Ottaiano A, Nasti G, Silvestro L, Cassata A, Grassi F, Avallone A, Izzo F, Petrillo A. Colorectal liver metastases patients prognostic assessment: prospects and limits of radiomics and radiogenomics. Infect Agent Cancer 2023; 18:18. [PMID: 36927442 PMCID: PMC10018963 DOI: 10.1186/s13027-023-00495-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
In this narrative review, we reported un up-to-date on the role of radiomics to assess prognostic features, which can impact on the liver metastases patient treatment choice. In the liver metastases patients, the possibility to assess mutational status (RAS or MSI), the tumor growth pattern and the histological subtype (NOS or mucinous) allows a better treatment selection to avoid unnecessary therapies. However, today, the detection of these features require an invasive approach. Recently, radiomics analysis application has improved rapidly, with a consequent growing interest in the oncological field. Radiomics analysis allows the textural characteristics assessment, which are correlated to biological data. This approach is captivating since it should allow to extract biological data from the radiological images, without invasive approach, so that to reduce costs and time, avoiding any risk for the patients. Several studies showed the ability of Radiomics to identify mutational status, tumor growth pattern and histological type in colorectal liver metastases. Although, radiomics analysis in a non-invasive and repeatable way, however features as the poor standardization and generalization of clinical studies results limit the translation of this analysis into clinical practice. Clear limits are data-quality control, reproducibility, repeatability, generalizability of results, and issues related to model overfitting.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy.
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, Napoli, Italy.,Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, Milan, 20122, Italy
| | - Sergio Venanzio Setola
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Roberta Galdiero
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Nicola Maggialetti
- Department of Medical Science, Neuroscience and Sensory Organs (DSMBNOS), University of Bari "Aldo Moro", Bari, 70124, Italy
| | - Renato Patrone
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, 80131, Italy
| | - Alessandro Ottaiano
- Clinical Sperimental Abdominal Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, 80131, Italy
| | - Guglielmo Nasti
- Clinical Sperimental Abdominal Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, 80131, Italy
| | - Lucrezia Silvestro
- Clinical Sperimental Abdominal Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, 80131, Italy
| | - Antonio Cassata
- Clinical Sperimental Abdominal Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, 80131, Italy
| | - Francesca Grassi
- Division of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, 80138, Italy
| | - Antonio Avallone
- Clinical Sperimental Abdominal Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, 80131, Italy
| | - Francesco Izzo
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, 80131, Italy
| | - Antonella Petrillo
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
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14
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Prognostic circulating proteomic biomarkers in colorectal liver metastases. Comput Struct Biotechnol J 2023; 21:2129-2136. [PMID: 36992914 PMCID: PMC10041383 DOI: 10.1016/j.csbj.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
The liver is the most common site of metastasis in colorectal cancer. Multimodal treatment, including liver resection, is potentially curative and prolongs survival for selected patients with colorectal liver metastases (CRLM). However, the treatment of CRLM remains challenging because recurrence is common, and prognosis varies widely between patients despite curative-intent treatment. Clinicopathological features and tissue-based molecular biomarkers, either alone or in combination, are insufficient for accurate prognostication. As most of the functional information in cells resides in the proteome, circulating proteomic biomarkers may be useful for rationalising the molecular complexities of CRLM and identifying potentially prognostic molecular subtypes. High-throughput proteomics has accelerated a range of applications including protein profiling of liquid biopsies for biomarker discovery. Moreover, these proteomic biomarkers may provide non-invasive prognostic information even before CRLM resection. This review evaluates recently discovered circulating proteomic biomarkers in CRLM. We also highlight some of the challenges and opportunities with translating these discoveries into clinical applications.
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15
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Berardi G, D'Angelica M. ASO Author Reflections: Upfront Surgery for Resectable Colorectal Liver Metastases: Biology is (Still) King. Ann Surg Oncol 2023; 30:2828-2829. [PMID: 36702999 DOI: 10.1245/s10434-023-13123-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Giammauro Berardi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
| | - Michael D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
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16
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Cutolo C, Fusco R, Simonetti I, De Muzio F, Grassi F, Trovato P, Palumbo P, Bruno F, Maggialetti N, Borgheresi A, Bruno A, Chiti G, Bicci E, Brunese MC, Giovagnoni A, Miele V, Barile A, Izzo F, Granata V. Imaging Features of Main Hepatic Resections: The Radiologist Challenging. J Pers Med 2023; 13:jpm13010134. [PMID: 36675795 PMCID: PMC9862253 DOI: 10.3390/jpm13010134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/31/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Liver resection is still the most effective treatment of primary liver malignancies, including hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), and of metastatic disease, such as colorectal liver metastases. The type of liver resection (anatomic versus non anatomic resection) depends on different features, mainly on the type of malignancy (primary liver neoplasm versus metastatic lesion), size of tumor, its relation with blood and biliary vessels, and the volume of future liver remnant (FLT). Imaging plays a critical role in postoperative assessment, offering the possibility to recognize normal postoperative findings and potential complications. Ultrasonography (US) is the first-line diagnostic tool to use in post-surgical phase. However, computed tomography (CT), due to its comprehensive assessment, allows for a more accurate evaluation and more normal findings than the possible postoperative complications. Magnetic resonance imaging (MRI) with cholangiopancreatography (MRCP) and/or hepatospecific contrast agents remains the best tool for bile duct injuries diagnosis and for ischemic cholangitis evaluation. Consequently, radiologists should be familiar with the surgical approaches for a better comprehension of normal postoperative findings and of postoperative complications.
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Affiliation(s)
- Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Napoli, Italy
- Correspondence:
| | - Igino Simonetti
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Francesca Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80127 Naples, Italy
| | - Piero Trovato
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Federico Bruno
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Nicola Maggialetti
- Department of Medical Science, Neuroscience and Sensory Organs (DSMBNOS), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Alessandra Borgheresi
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Alessandra Bruno
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Giuditta Chiti
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Eleonora Bicci
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Antonio Barile
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Francesco Izzo
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
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17
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Aquina CT, Brown ZJ, Beane JD, Ejaz A, Cloyd JM, Tsung A, Adam MO, Pawlik TM, Kim AC. Disparities in Care Access to Liver-Directed Therapy Among Medicare Beneficiaries with Colorectal Cancer Liver Metastasis. Ann Surg Oncol 2023; 30:335-344. [PMID: 36149611 PMCID: PMC9510323 DOI: 10.1245/s10434-022-12513-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/24/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Liver-directed therapies (LDT) are important components of the multidisciplinary care of patients with colorectal cancer liver metastases (CRCLM) that contribute to improved long-term outcomes. Factors associated with receipt of LDT are poorly understood. PATIENTS AND METHODS Patients > 65 years old diagnosed with CRCLM were identified within the Medicare Standard Analytic File (2013-2017). Patients with extrahepatic metastatic disease were excluded. Mixed-effects analyses were used to assess patient factors associated with the primary outcome of LDT, defined as hepatectomy, ablation, and/or hepatic artery infusion chemotherapy (HAIC), as well as the secondary outcome of hepatectomy. RESULTS Among 23,484 patients with isolated CRCLM, only 2004 (8.5%) received LDT, although resectability status could not be determined for the entire cohort. Among patients who received LDT, 61.7% underwent hepatectomy alone, 28.1% received ablation alone, 8.5% underwent hepatectomy and ablation, and 1.8% received HAIC either alone (0.8%) or in combination with hepatectomy and/or ablation (0.9%). Patient factors independently associated with lower odds of LDT included older age, female sex, Black race, greater comorbidity burden, higher social vulnerability index, primary rectal cancer, synchronous liver metastasis, and further distance from a high-volume liver surgery center (p < 0.05). Results were similar for receipt of hepatectomy. CONCLUSIONS Despite the well-accepted role of LDT for CRCLM, only a small proportion of Medicare beneficiaries with CRCLM receive LDT. Increasing access to specialized centers with expertise in LDT, particularly for Black patients, female patients, and those with higher levels of social vulnerability or long travel distances, may improve outcomes for patients with CRCLM.
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Affiliation(s)
- Christopher T Aquina
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Surgical Health Outcomes Consortium (SHOC), Digestive Health and Surgery Institute, AdventHealth Orlando, Orlando, FL, USA.
| | - Zachary J Brown
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joal D Beane
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aslam Ejaz
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Allan Tsung
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mohamed O Adam
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alex C Kim
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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18
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Lopez‐Lopez V, Linecker M, Cruz J, Brusadin R, Lopez‐Conesa A, Machado MA, Hernandez‐Alejandro R, Voskanyan AS, Li J, Balci D, Adam R, Ardiles V, De Santibañes E, Tomassini F, Troisi RI, Lurje G, Truant S, Pruvot F, Björnsson B, Stojanovic M, Montalti R, Cayuela V, Kozyrin I, Cai X, de Vicente E, Rauchfuss F, Lodge P, Ratti F, Aldrighetti L, Oldhafer KJ, Malago M, Petrowsky H, Clavien P, Robles‐Campos R. Liver growth prediction in ALPPS - A multicenter analysis from the international ALPPS registry. Liver Int 2022; 42:2815-2829. [PMID: 35533020 PMCID: PMC9796398 DOI: 10.1111/liv.15287] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/25/2022] [Accepted: 04/30/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND While ALPPS triggers a fast liver hypertrophy, it is still unclear which factors matter most to achieve accelerated hypertrophy within a short period of time. The aim of the study was to identify patient-intrinsic factors related to the growth of the future liver remnant (FLR). METHODS This cohort study is composed of data derived from the International ALPPS Registry from November 2011 and October 2018. We analyse the influence of demographic, tumour type and perioperative data on the growth of the FLR. The volume of the FLR was calculated in millilitre and percentage using computed-tomography (CT) scans before and after stage 1, both according to Vauthey formula. RESULTS A total of 734 patients were included from 99 centres. The median sFLR at stage 1 and stage 2 was 0.23 (IQR, 0.18-0.28) and 0.39 (IQR: 0.31-0.46), respectively. The variables associated with a lower increase from sFLR1 to sFLR2 were age˃68 years (p = .02), height ˃1.76 m (p ˂ .01), weight ˃83 kg (p ˂ .01), BMI˃28 (p ˂ .01), male gender (p ˂ .01), antihypertensive therapy (p ˂ .01), operation time ˃370 minutes (p ˂ .01) and hospital stay˃14 days (p ˂ .01). The time required to reach sufficient volume for stage 2, male gender accounts 40.3% in group ˂7 days, compared with 50% of female, and female present 15.3% in group ˃14 days compared with 20.6% of male. CONCLUSIONS Height, weight, FLR size and gender could be the variables that most constantly influence both daily growths, the interstage increase and the standardized FLR before the second stage.
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Affiliation(s)
- Victor Lopez‐Lopez
- Virgen de la Arrixaca Clinic and University HospitalDepartament of Surgery and TransplantationIMIB‐ArrixacaMurciaSpain
| | - Michael Linecker
- Department of Surgery and TransplantationUniversity Medical Center Schleswig‐HolsteinCampus KielGermany
| | - Juan Cruz
- Group of Applied Mathematics in Science and Engineering, Faculty of Computer ScienceUniversity of MurciaMurciaSpain
| | - Roberto Brusadin
- Virgen de la Arrixaca Clinic and University HospitalDepartament of Surgery and TransplantationIMIB‐ArrixacaMurciaSpain
| | - Asuncion Lopez‐Conesa
- Virgen de la Arrixaca Clinic and University HospitalDepartament of Surgery and TransplantationIMIB‐ArrixacaMurciaSpain
| | | | - Roberto Hernandez‐Alejandro
- Division of Transplantation/Hepatobiliary Surgery, Department of SurgeryUniversity of RochesterRochesterNew YorkUSA
| | | | - Jun Li
- Department of General, Visceral and Thoracic SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Deniz Balci
- Department of SurgeryAnkara UniversityAnkaraTurkey
| | - René Adam
- Centre Hépato‐BiliaireHôpital Paul BrousseVillejuifFrance
| | - Victoria Ardiles
- Liver Transplant Unit, Division of HPB Surgery, Department of SurgeryItalian Hospital Buenos AiresArgentina
| | - Eduardo De Santibañes
- Liver Transplant Unit, Division of HPB Surgery, Department of SurgeryItalian Hospital Buenos AiresArgentina
| | - Federico Tomassini
- Department of Oncological and Emergency SurgeryPoliclinico CasilinoRomeItaly
| | - Roberto I. Troisi
- Division of HPB Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and SurgeryFederico II University HospitalNaplesItaly
| | - Georg Lurje
- Department of Surgery, Campus Charité Mitte and Campus Virchow‐KlinikumCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Stéphanie Truant
- Department of Digestive Surgery and TransplantationUniversity HospitalLilleFrance
| | - Francois‐René Pruvot
- Department of Digestive Surgery and TransplantationUniversity HospitalLilleFrance
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | | | - Roberto Montalti
- Division of HPB Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and SurgeryFederico II University HospitalNaplesItaly
| | - Valentin Cayuela
- Virgen de la Arrixaca Clinic and University HospitalDepartament of Surgery and TransplantationIMIB‐ArrixacaMurciaSpain
| | - Ivan Kozyrin
- Department of Thoracic and Abdominal Surgery and OncologyClinical Hospital #1 MEDSIMoscowRussia
| | - Xiujun Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | | | - Falk Rauchfuss
- Department of General, Visceral and Vascular SurgeryJena University HospitalJenaGermany
| | - Peter Lodge
- HPB and Transplant UnitSt. James's University HospitalLeedsUK
| | - Francesca Ratti
- Hepatobiliary Surgery Division, Department of SurgeryIRCCS San Raffaele Hospital, School of MedicineMilanItaly
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, Department of SurgeryIRCCS San Raffaele Hospital, School of MedicineMilanItaly
| | - Karl J. Oldhafer
- Department of Surgery, Division of Liver‐, Bileduct‐ and Pancreatic SurgeryAsklepios Hospital BarmbekHamburgGermany
| | - Massimo Malago
- Department of HPB‐ and Liver Transplantation SurgeryUniversity College London, Royal Free HospitalsLondonUK
| | - Henrik Petrowsky
- Swiss HPB and Transplantation Center, Department of SurgeryUniversity Hospital ZurichZurichSwitzerland
| | - Pierre‐Alain Clavien
- Swiss HPB and Transplantation Center, Department of SurgeryUniversity Hospital ZurichZurichSwitzerland
| | - Ricardo Robles‐Campos
- Virgen de la Arrixaca Clinic and University HospitalDepartament of Surgery and TransplantationIMIB‐ArrixacaMurciaSpain
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19
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Wong GYM, Bhimani N, Mol B, Diakos C, de Reuver P, Molloy MP, Hugh TJ. Performance of prognostic models incorporating KRAS mutation status to predict survival after resection of colorectal liver metastases. HPB (Oxford) 2022; 24:1316-1325. [PMID: 35093297 DOI: 10.1016/j.hpb.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/02/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Genetic And Morphologic Evaluation (GAME) score and modified clinical score (m-CS) are two novel prognostic models that incorporate KRAS mutation status to predict survival after resection of colorectal liver metastases (CRLM). This retrospective cohort study evaluated the performance of these two models. METHODS A total of 103 patients who underwent resection of CRLM between 2007 and 2017 and had known KRAS mutation status were included, 39 (37.9%) of whom had KRAS mutated tumours. Complete case analysis of the patients was performed according to the Clinical Risk Score (CRS), m-CS, and GAME score. The primary outcome was overall survival stratified according to low-risk and high-risk scores. Harrell's C-index and Akaike information criterion (AIC) were used to compare the discrimination of the evaluated prognostic models. RESULTS The GAME score demonstrated the largest difference in overall survival for patients stratified according to low-risk and high-risk groups. Harrell's C-index values for the CRS, m-CS, and GAME models were 0.583, 0.600, and 0.668, respectively. AIC values for the CRS, m-CS, and GAME models were 441, 439, and 427, respectively. CONCLUSION The GAME score outperforms the CRS and m-CS in predicting overall survival after resection of CRLM in patients with known KRAS mutation status.
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Affiliation(s)
- Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
| | - Nazim Bhimani
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Barend Mol
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Connie Diakos
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Philip de Reuver
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Mark P Molloy
- Bowel Cancer and Biomarker Research Laboratory, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas J Hugh
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
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20
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Ghamarnejad O, Stavrou GA. Parenchymsparende Operationen oder anatomische Resektionen bei
Lebermetastasen des kolorektalen Karzinoms? Zentralbl Chir 2022; 147:381-388. [DOI: 10.1055/a-1844-0391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ZusammenfassungDarmkrebs ist eine der häufigsten Todesursachen in der westlichen Welt. Die
Hälfte der Patienten entwickelt kolorektale Lebermetastasen (CRLM), dabei weisen
weniger als 30% der Patienten zum Zeitpunkt der Diagnose eine chirurgisch
resektable Metastasierung auf. Im Falle einer Resektabilität bietet die
klassische anatomische (Major-)Hepatektomie eine hohe R0-Resektionsrate,
allerdings bei gleichzeitig erhöhter Morbidität und Mortalität. In den letzten 2
Jahrzehnten wurden die potenziellen Vorteile der parenchymsparenden Hepatektomie
(PSH) in Bezug auf die onkologischen Gesamtergebnisse, das Überleben und die
Re-Resektion im Falle eines Rezidivs („Salvageability“) nachgewiesen. Der
Beitrag fasst die aktuellen Erkenntnisse zur PSH als chirurgische Therapieoption
zusammen und diskutiert den aktuellen „state of the art“ in verschiedenen
Szenarien.
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Affiliation(s)
- Omid Ghamarnejad
- Allgemein-, Viszeral und Thoraxchirurgie, Chirurgische
Onkologie, Klinikum Saarbrücken gGmbH, Saarbrücken, Deutschland
| | - Gregor Alexander Stavrou
- Allgemein- Vszeral und Thoraxchirurgie, Chirurgische
Onkologie, Klinikum Saarbrücken gGmbH, Saarbrücken, Deutschland
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21
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Cao G, Wang X, Chen H, Gao S, Guo J, Liu P, Xu H, Xu L, Zhu X, Yang R. Hepatic arterial infusion chemotherapy plus regorafenib in advanced colorectal cancer: a real-world retrospective study. BMC Gastroenterol 2022; 22:328. [PMID: 35788189 PMCID: PMC9251591 DOI: 10.1186/s12876-022-02344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Hepatic arterial infusion chemotherapy delivers the drug directly to the liver. We aim to explore the benefits and tolerability of Hepatic arterial infusion chemotherapy plus regorafenib in advanced colorectal liver metastasis refractory to standard systemic chemotherapy. Methods This study analyzed 47 patients treated with hepatic arterial infusion chemotherapy plus regorafenib after standard systemic oxaliplatin and/or irinotecan in combination with bevacizumab or cetuximab between Jan 2017 and Jun 2020. Regorafenib was given for only 3 weeks in a 4-week cycle. Results Among 47 patients, 32 (68%) were males. The median age was 61 (29–75). With a median follow-up of 22.2 months (3.7–50.7 months). Before Hepatic arterial infusion chemotherapy administration in combination with regorafenib, 34 (72.3%) patients previously received ≥ 2 prior lines of systemic therapy and 37 (78.7%)patients previously received targeted biological treatment (anti-VEGF or anti-EGFR, or both). The initial doses of regorafenib were 40 mg/d (n = 1, 2.13%), 80 mg/d (n = 11, 23.43%), 120 mg/d (n = 2, 4.26%), and 160 mg/d (n = 23, 48.94%), while for 24.6% (n = 14) dose was unknown. Median Overall Survival was 22.2 months. Median Progression-Free Survival was 10.8 (95% CI: 9.0–13.7) months. Common Adverse Events were hand-foot skin reaction (12.77%), fatigue (6.38%), vomiting (6.38%), and decreased appetite (6.38%). Only 2 patients discontinued regorafenib due to Adverse Events. Conclusions Regorafenib combined with Hepatic arterial infusion was effective and tolerable in patients with liver predominant metastasis of colorectal cancer. Hence, this therapy can be considered as an alternative for second- or subsequent lines of therapy in patients refractory to standard systemic chemotherapy.
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Affiliation(s)
- Guang Cao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
| | - Xiaodong Wang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hui Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Song Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Jianhai Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Peng Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Haifeng Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Liang Xu
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xu Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
| | - Renjie Yang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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22
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Prognostic Models Incorporating RAS Mutation to Predict Survival in Patients with Colorectal Liver Metastases: A Narrative Review. Cancers (Basel) 2022; 14:cancers14133223. [PMID: 35804994 PMCID: PMC9264993 DOI: 10.3390/cancers14133223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/26/2022] [Accepted: 06/26/2022] [Indexed: 02/01/2023] Open
Abstract
Recurrence and survival vary widely among patients who undergo curative-intent resection of colorectal liver metastases (CRLM). Prognostic models provide estimated probabilities of these outcomes and allow the effects of multiple potentially interacting variables to be adjusted and assessed simultaneously. Although many prognostic models based on clinicopathologic factors have been developed since the 1990s to predict survival after resection of CRLM, these models vary in their predictive performance when applied to contemporary cohorts. Rat sarcoma viral oncogene homolog (RAS) mutation status is routinely tested in patients with metastatic colorectal cancer to predict response to anti-epidermal growth factor therapy. In addition, mutations in RAS predict survival and recurrence in patients undergoing hepatectomy for CRLM. Several recent prognostic models have incorporated RAS mutation status as a surrogate of tumor biology and combined revised clinicopathologic variables to improve the prediction of recurrence and survival. This narrative review aims to evaluate the differences between contemporary prognostic models incorporating RAS mutation status and their clinical applicability in patients considered for curative-intent resection of CRLM.
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23
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Wong GYM, Mol B, Bhimani N, Reuver P, Diakos C, Molloy MP, Hugh TJ. Recurrence patterns predict survival after resection of colorectal liver metastases. ANZ J Surg 2022; 92:2149-2156. [PMID: 35666139 PMCID: PMC9544678 DOI: 10.1111/ans.17835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/13/2022] [Accepted: 05/22/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery Unit Royal North Shore Hospital Sydney New South Wales Australia
- Northern Clinical School University of Sydney Sydney New South Wales Australia
| | - Barend Mol
- Department of Upper Gastrointestinal Surgery Unit Royal North Shore Hospital Sydney New South Wales Australia
| | - Nazim Bhimani
- Department of Upper Gastrointestinal Surgery Unit Royal North Shore Hospital Sydney New South Wales Australia
| | - Philip Reuver
- Department of Surgery Radboud University Medical Centre Nijmegen The Netherlands
| | - Connie Diakos
- Northern Clinical School University of Sydney Sydney New South Wales Australia
- Department of Medical Oncology Royal North Shore Hospital Sydney New South Wales Australia
| | - Mark P. Molloy
- Bowel Cancer and Biomarker Research Laboratory, School of Medical Sciences The University of Sydney Sydney New South Wales Australia
| | - Thomas J. Hugh
- Department of Upper Gastrointestinal Surgery Unit Royal North Shore Hospital Sydney New South Wales Australia
- Northern Clinical School University of Sydney Sydney New South Wales Australia
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24
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Eppenga R, Heerink W, Smit J, Kuhlmann K, Ruers T, Nijkamp J. Real-Time Wireless Tumor Tracking in Navigated Liver Resections: An Ex Vivo Feasibility Study. Ann Surg Oncol 2022; 29:3951-3960. [PMID: 35195825 PMCID: PMC9072277 DOI: 10.1245/s10434-022-11364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical navigation systems generally require intraoperative steps, such as intraoperative imaging and registration, to link the system to the patient anatomy. Because this hampers surgical workflow, we developed a plug-and-play wireless navigation system that does not require any intraoperative steps. In this ex vivo study on human hepatectomy specimens, the feasibility was assessed of using this navigation system to accurately resect a planned volume with small margins to the lesion. METHODS For ten hepatectomy specimens, a planning CT was acquired in which a virtual spherical lesion with 5 mm margin was delineated, inside the healthy parenchyma. Using two implanted trackers, the real-time position of this planned resection volume was visualized on a screen, relative to the used tracked pointer. Experienced liver surgeons were asked to accurately resect the nonpalpable planned volume, fully relying on the navigation screen. Resected and planned volumes were compared using CT. RESULTS The surgeons resected the planned volume while cutting along its border with a mean accuracy of - 0.1 ± 2.4 mm and resected 98 ± 12% of the planned volume. Nine out of ten resections were radical and one case showed a cut of 0.8 mm into the lesion. The sessions took approximately 10 min each, and no considerable technical issues were encountered. CONCLUSIONS This ex vivo liver study showed that it is feasible to accurately resect virtual hepatic lesions with small planned margins using our novel navigation system, which is promising for clinical applications where nonpalpable hepatic metastases have to be resected with small resection margins.
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Affiliation(s)
- Roeland Eppenga
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Wout Heerink
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jasper Smit
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Koert Kuhlmann
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Theo Ruers
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Nanobiophysics Group, Faculty TNW, University of Twente, Enschede, The Netherlands
| | - Jasper Nijkamp
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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25
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Wong GYM, Diakos C, Hugh TJ, Molloy MP. Proteomic Profiling and Biomarker Discovery in Colorectal Liver Metastases. Int J Mol Sci 2022; 23:ijms23116091. [PMID: 35682769 PMCID: PMC9181741 DOI: 10.3390/ijms23116091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022] Open
Abstract
Colorectal liver metastases (CRLM) are the leading cause of death among patients with metastatic colorectal cancer (CRC). As part of multimodal therapy, liver resection is the mainstay of curative-intent treatment for select patients with CRLM. However, effective treatment of CRLM remains challenging as recurrence occurs in most patients after liver resection. Proposed clinicopathologic factors for predicting recurrence are inconsistent and lose prognostic significance over time. The rapid development of next-generation sequencing technologies and decreasing DNA sequencing costs have accelerated the genomic profiling of various cancers. The characterisation of genomic alterations in CRC has significantly improved our understanding of its carcinogenesis. However, the functional context at the protein level has not been established for most of this genomic information. Furthermore, genomic alterations do not always result in predicted changes in the corresponding proteins and cancer phenotype, while post-transcriptional and post-translational regulation may alter synthesised protein levels, affecting phenotypes. More recent advancements in mass spectrometry-based technology enable accurate protein quantitation and comprehensive proteomic profiling of cancers. Several studies have explored proteomic biomarkers for predicting CRLM after oncologic resection of primary CRC and recurrence after curative-intent resection of CRLM. The current review aims to rationalise the proteomic complexity of CRC and explore the potential applications of proteomic biomarkers in CRLM.
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Affiliation(s)
- Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW 2065, Australia;
- Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia;
- Correspondence:
| | - Connie Diakos
- Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia;
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Thomas J. Hugh
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW 2065, Australia;
- Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia;
| | - Mark P. Molloy
- Bowel Cancer and Biomarker Research Laboratory, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW 2006, Australia;
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26
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Dakua SP, Nayak A. A review on treatments of hepatocellular carcinoma—role of radio wave ablation and possible improvements. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Currently, several treatment options are available for liver cancer depending on various factors such as location, size, shape, and liver function. Image fusion is required for the diagnosis, intervention, and follow-up of certain HCCs. Presently, mental fusion is the only way while diagnosing liver lesions by comparing the ultrasound (US) image with the computed tomography (CT) image. Nevertheless, mental fusion is bound to have errors. The objective of this paper is to study the present treatment options for hepatocellular carcinoma and review the present treatment options, list out their potential limitations, and present a possible alternative solution based on the findings to reduce errors and mistargeting.
Methods
This is a systematic review on the present treatment options for hepatocellular carcinoma, especially radio wave ablation.
Results
It is found that computer fusion is the possible alternative to the present mental registration.
Conclusions
Although computer fusion is the best alternative to use radio wave ablation, there have been a few open-ended questions to further explore.
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27
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Frosio F, Cervantes B, Nassar A, Faermark N, Sanou Y, Bonnet S, Lefevre M, Louvet C, Gayet B, Fuks D. Prognostic role of infracentimetric colorectal liver metastases. Langenbecks Arch Surg 2022; 407:1971-1980. [DOI: 10.1007/s00423-022-02499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
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28
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Zhou N, Guo X, Sun H, Yu B, Zhu H, Li N, Yang Z. The Value of 18F-FDG PET/CT and Abdominal PET/MRI as a One-Stop Protocol in Patients With Potentially Resectable Colorectal Liver Metastases. Front Oncol 2021; 11:714948. [PMID: 34858808 PMCID: PMC8630637 DOI: 10.3389/fonc.2021.714948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/20/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose The aim of this study was to evaluate the clinical value of simultaneous positron emission tomography/computed tomography (PET/CT) and abdominal positron emission tomography/magnet resonance imaging (PET/MRI) in the detection of liver metastases and extrahepatic disease (EHD) in patients with potentially resectable colorectal liver metastases (CLM). Methods Fifty-six patients with CLM underwent conventional imaging (chest and abdomen CT, liver contrast-enhanced CT or MRI) and PET imaging [fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT and subsequent liver PET/MRI] for staging or restaging. Diagnostic ability of PET imaging was compared with conventional imaging. Abnormal findings were correlated with follow-up imaging and/or histology. The influence of the PET imaging findings was categorized for each patient in relation to operability and other significant findings. The clinical management included three modalities (surgery for resectable CLM, unresectable CLM with conversion treatment, and systemic therapy). The clinical impact of the imaging modality was analyzed. The operative histopathological analysis and/or imaging follow-up were performed as the standard of reference. Results This study enrolled a total of 56 patients (median age 60 years, 62.5% were male, 36 with colon cancer and 20 with rectal cancer). For EHD detection, PET/CT detected more EHD than conventional imaging (60.7% vs. 46.4%). PET/CT had different findings in 19 (33.9%) patients, including downstaging in 4 (7.1%) patients and upstaging in 15 (26.8%) patients. For liver lesion detection, PET/MRI showed comparable detection ability with CE-MRI and CE-CT (99.5%, 99.4%, and 86.5%, respectively) based on lesion analysis, much higher than PET/CT (47.5%). PET imaging had a major impact in 10/56 (17.9%) patients (4 from unresectable to resectable, 6 from resectable to unresectable) and a minor impact in 4/56 (7.1%) patients for changing the surgery extent. The therapeutic strategies had been altered in a total of 14/56 patients (25%) after PET/CT and PET/MRI scans. Conclusion The results of this study indicate that simultaneous 18F-FDG PET/CT and abdominal PET/MRI scans can provide accurate information regarding CLM status and EHD, and can affect the management of 25% of the patients by changing the therapeutic strategies determined by conventional imaging. This new modality may serve as a new one-stop method in patients with potentially resectable CLM.
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Affiliation(s)
- Nina Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaoyi Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, China
| | - Hongwei Sun
- United Imaging Research Institute of Intelligent Imaging, Beijing, China
| | - Boqi Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, China
| | - Hua Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, China
| | - Nan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhi Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, China
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29
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Liu Y, Chang W, Zhou B, Wei Y, Tang W, Liang F, Chen Y, Yan Z, Lv M, Ren L, Xu J. Conventional transarterial chemoembolization combined with systemic therapy versus systemic therapy alone as second-line treatment for unresectable colorectal liver metastases: randomized clinical trial. Br J Surg 2021; 108:373-379. [PMID: 33611431 DOI: 10.1093/bjs/znaa155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/22/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The combination of conventional transarterial chemoembolization (cTACE) and systemic therapy has the potential to treat chemotherapy-refractory unresectable colorectal liver metastases (CRLMs). This study aimed to compare survival after this combined treatment versus systemic chemotherapy alone. METHODS This single-centre RCT included patients with unresectable CRLMs that progressed after first-line treatment. Patients were randomized on a 1 : 1 basis to either systemic chemotherapy with or without cTACE, without further stratification. The primary outcome was progression-free survival (PFS). Secondary outcomes were overall response rate, disease control rate, conversion rate to liver resection, overall survival, and adverse events. RESULTS Of 180 patients recruited, 168 were randomized. Eighty-five patients in arm A received systemic chemotherapy plus cTACE and 83 in arm B received systemic chemotherapy alone. Median PFS was longer in arm A than B (6.7 versus 3.8 months; hazard ratio (HR) 0.67, 95 per cent c.i. 0.49 to 0.91; P = 0.009), but did not translate into prolonged median overall survival (18.4 versus 14.8 months; HR = 0.92, 0.62 to 1.36; P = 0.669). Overall response rates (20 versus 22 per cent; P = 0.788) and conversion rate to liver resection (18 versus 16 per cent; P = 0.730) were no different between arms A and B. The disease control rate was higher in arm A than arm B (67 versus 51 per cent; P = 0.030). No adverse event higher than grade 3 according to the Common Terminology Criteria for Adverse Events was observed during treatment. CONCLUSION Systemic chemotherapy plus cTACE is a safe option as second-line treatment for unresectable colorectal liver metastases, with a modest effect on PFS. Registration number: NCT03783559 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Y Liu
- Colorectal Cancer Centre, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - W Chang
- Colorectal Cancer Centre, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Centre of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - B Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Y Wei
- Colorectal Cancer Centre, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Centre of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - W Tang
- Colorectal Cancer Centre, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Centre of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - F Liang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Y Chen
- Colorectal Cancer Centre, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Z Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - M Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - L Ren
- Colorectal Cancer Centre, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Centre of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - J Xu
- Colorectal Cancer Centre, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Centre of Colorectal Cancer Minimally Invasive, Shanghai, China
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30
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Hellingman T, Kuiper BI, Buffart LM, Meijerink MR, Versteeg KS, Swijnenburg RJ, van Delden OM, Haasbeek CJA, de Vries JJJ, van Waesberghe JHTM, Zonderhuis BM, van der Vliet HJ, Kazemier G. Survival Benefit of Repeat Local Treatment in Patients Suffering From Early Recurrence of Colorectal Cancer Liver Metastases. Clin Colorectal Cancer 2021; 20:e263-e272. [PMID: 34462211 DOI: 10.1016/j.clcc.2021.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/17/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND A uniform treatment strategy for patients suffering from early recurrence after local treatment of CRLM is currently lacking. The aim of this observational cohort study was to assess the potential survival benefit of repeat local treatment compared to systemic therapy in patients suffering from early recurrence of CRLM. PATIENTS AND METHODS Patients who developed recurrent CRLM within 12 months after initial local treatment with curative intent were retrospectively identified in Amsterdam University Medical Centers between 2009-2019. Differences in overall and progression-free survival among treatment strategies were assessed using multivariable Cox regression analyses. RESULTS A total of 135 patients were included. Median overall survival of 41 months [range 4-135] was observed in patients who received repeat local treatment, consisting of upfront or repeat local treatment after neoadjuvant systemic therapy, compared to 24 months [range 1-55] in patients subjected to systemic therapy alone (adjusted HR = 0.42 [95%-CI: 0.25-0.72]; P = .002). Prolonged progression-free survival was observed after neoadjuvant systemic therapy followed by repeat local treatment, as compared to upfront repeat local treatment in patients with recurrent CRLM within 4 months following initial local treatment of CRLM (adjusted HR = 0.36 [95%-CI: 0.15-0.86]; P = .021). CONCLUSION Patients with early recurrence of CRLM should be considered for repeat local treatment strategies. A multimodality approach, consisting of neoadjuvant systemic therapy followed by repeat local treatment, appeared favorable in patients with recurrence within 4 months following initial local treatment of CRLM.
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Affiliation(s)
- Tessa Hellingman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Babette I Kuiper
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Laurien M Buffart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Biostatistics, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Martijn R Meijerink
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Kathelijn S Versteeg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Rutger-Jan Swijnenburg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Otto M van Delden
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Cornelis J A Haasbeek
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Jan J J de Vries
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Jan Hein T M van Waesberghe
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Barbara M Zonderhuis
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Hans J van der Vliet
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, the Netherlands; Lava Therapeutics, Utrecht, the Netherlands
| | - Geert Kazemier
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
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Murtha-Lemekhova A, Fuchs J, Ghamarnejad O, Nikdad M, Probst P, Hoffmann K. Influence of cytokines, circulating markers and growth factors on liver regeneration and post-hepatectomy liver failure: a systematic review and meta-analysis. Sci Rep 2021; 11:13739. [PMID: 34215781 PMCID: PMC8253792 DOI: 10.1038/s41598-021-92888-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023] Open
Abstract
The pathophysiology of post-hepatectomy liver failure is not entirely understood but is rooted in the disruption of normal hepatocyte regeneration and homeostasis. Current investigations of post-hepatectomy liver failure and regeneration are focused on evaluation of circulating hepatic function parameters (transaminases, cholestasis, and coagulation parameters), volumetry and hepatic hemodynamics. However, identification of biochemical factors associated with regeneration and post hepatectomy liver failure is crucial for understanding the pathophysiology and identification of patients at risk. The objective of the present systematic review was to identify circulating factors associated with liver regeneration and post hepatectomy liver failure in patients undergoing hepatectomy. The quantitative analysis was intended if studies provided sufficient data. Electronic databases (MEDLINE via PubMed, Web of Knowledge, Cochrane Library and WHO International Clinical Trials Registry Platform) were searched for publications on cell signaling factors in liver regeneration and post-hepatectomy liver failure following liver resection in clinical setting. No date restriction was given. No language restriction was used. Studies were assessed using MINORS. This study was registered at PROSPERO (CRD42020165384) prior to data extraction. In total 1953 publications were evaluated for titles and abstracts after exclusion of duplicates. Full texts of 167 studies were further evaluated for inclusion. 26 articles were included in the review and 6 publications were included in the meta-analyses. High levels of serum hyaluronic acid even preoperatively are associated with PHLF but especially increased levels early after resection are predictive of PHLF with high sensitivity and specificity. Postoperative elevation of HA to levels between 100 and 500 ng/ml is increased the risk for PHLF ([OR] = 246.28, 95% [CI]: 11.82 to 5131.83; p = 0.0004) Inteleukin-6 levels show contradicting result in association with organ dysfunction. HGF positively correlates with liver regeneration. Overall, due to heterogeneity, scarcity, observational study design and largely retrospective analysis, the certainty of evidence, assessed with GRADE, is very low. High levels of serum hyaluronic acid show a strong association with PHLF and increased levels after resection are predictive of PHLF with high sensitivity and specificity, even on POD1. Interleukin-6 levels need to be studied further due to contradictive results in association with organ dysfunction. For HGF, no quantitative analysis could be made. Yet, most studies find positive correlation between high HGF levels and regeneration. Prospective studies investigating HGF and other growth factors, hyaluronic acid and interleukins 1 and 6 in correlation with liver regeneration measured sequentially through e.g. volumetry, and liver function parameters, preferably expanding the analysis to include dynamic liver function tests, are needed to sufficiently illustrate the connection between biomolecule levels and clinical outcomes.
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Affiliation(s)
- Anastasia Murtha-Lemekhova
- Department of General, Visceral, and Transplantation Surgery, Ruprecht Karl University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Juri Fuchs
- Department of General, Visceral, and Transplantation Surgery, Ruprecht Karl University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Omid Ghamarnejad
- Department of General, Visceral, and Transplantation Surgery, Ruprecht Karl University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Mohammedsadegh Nikdad
- Department of General, Visceral, and Transplantation Surgery, Ruprecht Karl University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral, and Transplantation Surgery, Ruprecht Karl University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- Study Center of the German Surgical Society (SDGC), Heidelberg University Hospital, Heidelberg, Germany
| | - Katrin Hoffmann
- Department of General, Visceral, and Transplantation Surgery, Ruprecht Karl University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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32
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Sakai N, Furukawa K, Takayashiki T, Kuboki S, Takano S, Ohtsuka M. Differential effects of KRAS mutational status on long-term survival according to the timing of colorectal liver metastases. BMC Cancer 2021; 21:412. [PMID: 33858364 PMCID: PMC8048293 DOI: 10.1186/s12885-021-08144-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
Background The relationship between KRAS mutational status and timing of colorectal liver metastasis (CRLM) remains unclear. This study evaluated the relationship between KRAS mutational status and long-term survival in patients with synchronous CRLM. Methods Of the 255 patients who underwent initial hepatic resection for CRLM between January 2001 and December 2018, the KRAS mutational status was examined in 101 patients. Medical records of these patients were reviewed to evaluate recurrence and survival outcomes. Results KRAS mutant status was identified in 38 patients (37.6%). The overall survival (OS) was significantly better in patients with wild-type KRAS than in those with mutant KRAS status. In patients with synchronous metastases, the OS of patients with wild-type KRAS was significantly better than those with mutant KRAS. Multivariate analyses indicated shorter OS to be independently associated with positive primary lymph node, and large tumor size and R1 resection in patients with metachronous metastasis, whereas to be independently associated with mutant KRAS status in patients with synchronous metastasis. Furthermore, in the subgroup of patients with synchronous metastases, the repeat resection rate for hepatic recurrence was significantly high in those with wild type KRAS than in those with mutant KRAS. Conclusion KRAS mutation is an independent prognostic factor in patients with synchronous CRLM, but not in patients with metachronous CRLM.
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Affiliation(s)
- Nozomu Sakai
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Katsunori Furukawa
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Tsukasa Takayashiki
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Satoshi Kuboki
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shigetsugu Takano
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
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33
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Luz JHM, Veloso Gomes F, Costa NV, Vasco I, Coimbra E, Luz PM, Marques HP, Coelho JS, Mega RMA, Ribeiro VNTV, da Costa Lamelas JTR, de Sampaio Nunes E Sobral MM, da Silva SRG, de Teixeira Carrelha AS, Rodrigues SCC, de Figueiredo AAFP, Santos MV, Bilhim T. BestFLR Trial: Liver Regeneration at CT before Major Hepatectomies for Liver Cancer-A Randomized Controlled Trial Comparing Portal Vein Embolization with N-Butyl-Cyanoacrylate Plus Iodized Oil versus Polyvinyl Alcohol Particles Plus Coils. Radiology 2021; 299:715-724. [PMID: 33825512 DOI: 10.1148/radiol.2021204055] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background In patients with liver cancer, portal vein embolization (PVE) is recommended to promote liver growth before major hepatectomies. However, the optimal embolization strategy has not been established. Purpose To compare liver regeneration as seen at CT in participants with liver cancer, before major hepatectomies, with N-butyl-cyanoacrylate (NBCA) plus iodized oil versus standard polyvinyl alcohol (PVA) particles plus coils, for PVE. Materials and Methods In this single-center, prospective, randomized controlled trial (Best Future Liver Remnant, or BestFLR, trial; International Standard Randomized Controlled Trial Number 16062796), PVE with NBCA plus iodized oil was compared with standard PVE with PVA particles plus coils in participants with liver cancer. Participant recruitment started in November 2017 and ended in March 2020. Participants were randomly assigned to undergo PVE with PVA particles plus coils or PVE with NBCA plus iodized oil. The primary end point was liver growth assessed with CT 14 days and 28 days after PVE. Secondary outcomes included posthepatectomy liver failure, surgical complications, and length of intensive care treatment and hospital stay. The Mann-Whitney U test was used to compare continuous outcomes according to PVE material, whereas the Χ2 test or Fisher exact test was used for categoric variables. Results Sixty participants (mean age, 61 years ± 11 [standard deviation]; 32 men) were assigned to the PVA particles plus coils group (n = 30) or to the NBCA plus iodized oil group (n = 30). Interim analysis revealed faster and superior liver hypertrophy for the NBCA plus iodized oil group versus the PVA particles plus coils group 14 days and 28 days after PVE (absolute hypertrophy of 46% vs 30% [P < .001] and 57% vs 37% [P < .001], respectively). Liver growth for the proposed hepatectomy was achieved in 87% of participants (26 of 30) in the NBCA plus iodized oil group versus 53% of participants (16 of 30) in the PVA particles plus coils group (P = .008) 14 days after PVE. Liver failure occurred in 13% of participants (three of 24) in the NBCA plus iodized oil group and in 27% of participants (six of 22) in the PVA particles plus coils group (P = .27). Conclusion Portal vein embolization with N-butyl-cyanoacrylate plus iodized oil produced greater and faster liver growth as seen at CT in participants with liver cancer, compared with portal vein embolization with polyvinyl alcohol particles plus coils, allowing for earlier surgical intervention. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Arellano in this issue.
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Affiliation(s)
- José Hugo Mendes Luz
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Filipe Veloso Gomes
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Nuno Vasco Costa
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Inês Vasco
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Elia Coimbra
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Paula Mendes Luz
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Hugo Pinto Marques
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - João Santos Coelho
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Raquel Maria Alexandre Mega
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Vasco Nuno Torres Vouga Ribeiro
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Jorge Tiago Rodrigues da Costa Lamelas
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Maria Mafalda de Sampaio Nunes E Sobral
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Sílvia Raquel Gomes da Silva
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Ana Sofia de Teixeira Carrelha
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Susana Cristina Cardoso Rodrigues
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - António Augusto Ferreira Pinto de Figueiredo
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Margarida Varela Santos
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Tiago Bilhim
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
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Bong JW, Ju Y, Seo J, Kang SH, Park PJ, Choi SB, Lee SI, Oh SC, Min BW. Effects of the proximity of metastasis to the central vessels of the liver on surgical outcomes and survival in colorectal cancer with liver metastasis. ANZ J Surg 2021; 91:E183-E189. [PMID: 33634960 DOI: 10.1111/ans.16655] [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: 12/10/2020] [Revised: 01/24/2021] [Accepted: 01/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Resectability of liver metastasis is important to establish a treatment strategy for patients with colorectal cancer. We aimed to evaluate the effect of the distance from metastasis to the centre of the liver on surgical outcomes and survival after hepatectomy. METHODS The clinical data of a total of 155 patients who underwent hepatectomy for colorectal cancer with liver metastasis were retrospectively reviewed. We measured the minimal length from metastasis to the bifurcation of the portal vein at the primary branch of the Glissonean tree and defined it as 'centrality'. The postoperative outcomes and survival among the patients were then analysed. RESULTS Anatomic resections were more frequently performed, and the operative time was longer in the patients with high centrality (≤1.5 cm) than in the patients with low centrality (>1.5 cm). A size of ≥5 cm for the largest lesion, a number of lesions of ≥3 and centrality of ≤1.5 cm were found to be the independent risk factors of a positive resection margin after hepatectomy. The patients with high centrality showed worse recurrence-free survival than those with low centrality; however, there was no significant difference found in the overall survival. In the multivariate analysis, high centrality was not found to be associated with worse recurrence-free and overall survival. CONCLUSION Centrality significantly affected the surgical outcomes and treatment strategy for liver metastasis but did not influence the survival of the patients with colorectal cancer. Active efforts through surgical resections are important to treat liver metastasis of high centrality.
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Affiliation(s)
- Jun Woo Bong
- Division of Colorectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yeonuk Ju
- Division of Colorectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jihyun Seo
- Division of Colorectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Hee Kang
- Division of Colorectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Pyoung-Jae Park
- Division of Transplantation and Vascular Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sae-Byeol Choi
- Division of Hepatobiliary Pancreas Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sun Il Lee
- Division of Colorectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Cheul Oh
- Division of Oncology/Hematology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung Wook Min
- Division of Colorectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Machairas N, Dorovinis P, Kykalos S, Stamopoulos P, Schizas D, Zoe G, Terra A, Nikiteas N. Simultaneous robotic-assisted resection of colorectal cancer and synchronous liver metastases: a systematic review. J Robot Surg 2021; 15:841-848. [PMID: 33598830 DOI: 10.1007/s11701-021-01213-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/06/2021] [Indexed: 12/14/2022]
Abstract
Simultaneous resections of primary colorectal cancer (CRC) and synchronous colorectal liver metastases (CRLM) have emerged as safe and efficient procedures for selected patients. Besides the traditional open approach for simultaneous resections, similar outcomes have been reported for minimally invasive approaches. Over the past years, a number of studies have sought to evaluate the safety and efficacy of simultaneous robotic-assisted resections (SRAR) for patients with synchronous CRC and CRLM. The objective of this systematic review is to evaluate the safety, technical feasibility and outcomes of SRAR of the primary CRC and CRLM. A comprehensive review of the literature was undertaken. Nine studies comprising a total of 29 patients (16 males) who underwent SRAR were considered eligible for inclusion. The primary tumor site was the rectum in 22 (76%) patients and the colon in 7 (24%) patients. A minor liver resection was performed in the majority of the cases (n = 24; 82%). The median operative time and estimated blood loss were 399.5 min (range 300-682) and 274 ml (range 10-780 ml), respectively. No cases of conversion to open were reported. The median LOS was 7 days (range 2-28 days). All patients reportedly underwent R0 resection. Overall and major morbidity rates were 38% and 7%, respectively, while no perioperative deaths were reported. Despite the limited number of studies, SRAR seems to be a safe and efficient minimally invasive approach for highly selected patients always implemented in the context of multidisciplinary patient management.
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Affiliation(s)
- Nikolaos Machairas
- 2nd Department of Propaedeutic Surgery, Nationals and Kapodistrian University of Athens, General Hospital Laiko, Ag. Thoma 17, 11527, Athens, Greece.
| | - Panagiotis Dorovinis
- 2nd Department of Propaedeutic Surgery, Nationals and Kapodistrian University of Athens, General Hospital Laiko, Ag. Thoma 17, 11527, Athens, Greece
| | - Stylianos Kykalos
- 2nd Department of Propaedeutic Surgery, Nationals and Kapodistrian University of Athens, General Hospital Laiko, Ag. Thoma 17, 11527, Athens, Greece
| | - Paraskevas Stamopoulos
- 2nd Department of Propaedeutic Surgery, Nationals and Kapodistrian University of Athens, General Hospital Laiko, Ag. Thoma 17, 11527, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, Nationals and Kapodistrian University of Athens, General Hospital Laiko, Athens, Greece
| | - Garoufalia Zoe
- 2nd Department of Propaedeutic Surgery, Nationals and Kapodistrian University of Athens, General Hospital Laiko, Ag. Thoma 17, 11527, Athens, Greece
| | - Alexis Terra
- 2nd Department of Propaedeutic Surgery, Nationals and Kapodistrian University of Athens, General Hospital Laiko, Ag. Thoma 17, 11527, Athens, Greece
| | - Nikolaos Nikiteas
- 2nd Department of Propaedeutic Surgery, Nationals and Kapodistrian University of Athens, General Hospital Laiko, Ag. Thoma 17, 11527, Athens, Greece
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Behrenbruch C, Prabhakaran S, Udayasiri D D, Michael M, Hollande F, Hayes I, Heriot AG, Knowles B, Thomson BN. Association between imaging response and survival following neoadjuvant chemotherapy in patients with resectable colorectal liver metastases: A cohort study. J Surg Oncol 2021; 123:1263-1273. [PMID: 33524184 DOI: 10.1002/jso.26400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/12/2020] [Accepted: 01/18/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND The association between the imaging response (structural or metabolic) to neoadjuvant chemotherapy (neoCT) before colorectal liver metastasis (CRLM) and survival is unclear. METHOD A total of 201 patients underwent their first CRLM resection. A total of 94 (47%) patients were treated with neoCT. A multivariable, Cox proportional hazard regression analysis was performed to compare overall survival (OS) and progression-free survival (PFS) between response groups. RESULTS Multivariable regression analysis of the CT/MRI (n = 94) group showed no difference in survival (OS and PFS) in patients who had stable disease/partial response (SD/PR) or complete response (CR) versus patients who had progressive disease (PD) (OS: HR, 0.36 (95% CI: 0.11-1.19) p = .094, HR, 0.78 (95% CI: 0.13-4.50) p = .780, respectively), (PFS: HR, 0.70 (95% CI: 0.36-1.35) p = .284, HR, 0.51 (0.18-1.45) p = .203, respectively). In the FDG-PET group (n = 60) there was no difference in the hazard of death for patients with SD/PR or CR versus patients with PD for OS or PFS except for the PFS in the small CR subgroup (OS: HR, 0.75 (95% CI: 0.11-4.88) p = .759, HR, 1.21 (95% CI: 0.15-9.43) p = .857), (PFS: HR, 0.34% (95% CI: 0.09-1.22), p = .097, HR, 0.17 (95% CI: 0.04-0.62) p = .008, respectively). CONCLUSION There was no convincing evidence of association between imaging response to neoCT and survival following CRLM resection.
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Affiliation(s)
- C Behrenbruch
- Sir Peter MacCallum Department of Oncology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia.,Department of Clinical Pathology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - S Prabhakaran
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia
| | - D Udayasiri D
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia.,Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.,Colorectal Surgery Unit, The Royal Melbourne Hospital, Parkville, Australia
| | - M Michael
- Sir Peter MacCallum Department of Oncology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia.,Department of Medical Oncology, Victorian Comprehensive Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - F Hollande
- Department of Clinical Pathology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia.,Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia
| | - I Hayes
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia.,Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.,Colorectal Surgery Unit, The Royal Melbourne Hospital, Parkville, Australia
| | - A G Heriot
- Sir Peter MacCallum Department of Oncology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia.,Department of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Department of Surgery, St Vincent's Hospital, The University of Melbourne, Fitzroy, Australia
| | - B Knowles
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia
| | - B N Thomson
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia.,Department of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
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Tsilimigras DI, Hyer JM, Bagante F, Guglielmi A, Ruzzenente A, Alexandrescu S, Poultsides G, Sasaki K, Aucejo F, Pawlik TM. Resection of Colorectal Liver Metastasis: Prognostic Impact of Tumor Burden vs KRAS Mutational Status. J Am Coll Surg 2020; 232:590-598. [PMID: 33383214 DOI: 10.1016/j.jamcollsurg.2020.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prognostic impact of colorectal liver metastasis (CRLM) morphologic characteristics relative to KRAS mutational status after hepatic resection remains ill defined. STUDY DESIGN Patients undergoing hepatectomy for CRLM between 2001 and 2018 were identified using an international multi-institutional database. Tumor burden score (TBS) was defined as distance from origin on a Cartesian plane that incorporated maximum tumor size (x-axis) and number of lesions (y-axis). Impact of TBS on overall survival (OS) relative to KRAS status (wild type [wtKRAS] vs mutated [mutKRAS]) was assessed. RESULTS Among 1,361 patients, the median number of metastatic lesions was 2 (interquartile range [IQR] 1-3), and median size of the largest metastatic lesion was 3.0 cm (IQR 2.0-5.0 cm), resulting in a median TBS of 4.1 (IQR 2.8-6.1); KRAS status was wtKRAS (n = 420, 30.9%), mutKRAS (n = 251, 18.4%), and unknown (n = 690, 50.7%). Overall median and 5-year OS were 49.5 months (95%CI 45.2-53.8) and 43.2%, respectively. In examining the entire cohort, TBS was associated with long-term prognosis (5-year OS, low TBS: 49.4% vs high TBS: 36.7%), as was KRAS mutational status (5-year OS, wtKRAS: 48.2% vs mutKRAS: 31.1%; unknown KRAS: 44.0%)(both p < 0.01). Among patients with wtKRAS tumors, TBS was strongly associated with improved OS (5-year OS, low TBS: 59.1% vs high TBS: 38.4%, p = 0.002); however, TBS failed to discriminate long-term prognosis among patients with mutKRAS tumors (5-year OS, low TBS: 37.4% vs high TBS: 26.7%, p = 0.19). In fact, patients with high TBS/wtKRAS CRLM had comparable outcomes to patients with low TBS/mutKRAS tumors (5-year OS, 38.4% vs 37.4%, respectively; p = 0.59). On multivariable analysis, while TBS was associated with OS among patients with wtKRAS CRLM (hazard ratio 1.43, 95%CI 1.02-2.00; p = 0.03), TBS was not an independent predictor of survival among patients with mutKRAS CRLM (HR 1.36, 95%CI 0.92-1.99; p = 0.12). CONCLUSIONS While TBS was associated with survival among patients with wtKRAS tumors, CRLM morphology was not predictive of long-term outcomes among patients with mutKRAS CRLM.
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Affiliation(s)
| | - J Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Fabio Bagante
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH; University of Verona, Verona, Italy
| | | | | | | | | | | | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
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Glinka J, Ardiles V, Pekolj J, de Santibañes E, de Santibañes M. The role of associating liver partition and portal vein ligation for staged hepatectomy in the management of patients with colorectal liver metastasis. Hepatobiliary Surg Nutr 2020; 9:694-704. [PMID: 33299825 DOI: 10.21037/hbsn.2019.08.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) approach emerged as a promising surgical strategy for rapid and large hypertrophy of the future liver remnant (FLR) when a major liver resection is necessary. Colorectal liver metastasis (CRLM) is their main indication. However, the promising results published so far, are very difficult to interpret since they usually focus on the technique and not on the underlying disease. Moreover, they are usually made up of complex populations, which received different chemotherapy schemes, with the ALPPS technical variations implemented over time and without consistent long-term follow-up results as well. Whereby, its role in CRLM should be analyzed as carefully as possible to indicate and select the best candidates who will benefit the most from this approach. We conducted a computerized search using PubMed and Google Scholar for reports published so far, using mesh headings and keywords related to the ALPPS and CRLM.
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Affiliation(s)
- Juan Glinka
- Department of General Surgery, Hepato-Bilio-Pancreatic & Liver Transplantation Unit Hospital Italiano de Buenos Aires, BuenosAires, Argentina
| | - Victoria Ardiles
- Department of General Surgery, Hepato-Bilio-Pancreatic & Liver Transplantation Unit Hospital Italiano de Buenos Aires, BuenosAires, Argentina
| | - Juan Pekolj
- Department of General Surgery, Hepato-Bilio-Pancreatic & Liver Transplantation Unit Hospital Italiano de Buenos Aires, BuenosAires, Argentina
| | - Eduardo de Santibañes
- Department of General Surgery, Hepato-Bilio-Pancreatic & Liver Transplantation Unit Hospital Italiano de Buenos Aires, BuenosAires, Argentina
| | - Martin de Santibañes
- Department of General Surgery, Hepato-Bilio-Pancreatic & Liver Transplantation Unit Hospital Italiano de Buenos Aires, BuenosAires, Argentina
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Battais A, Barrère V, N'Djin WA, Dupré A, Rivoire M, Melodelima D. Fast and Selective Ablation of Liver Tumors by High-Intensity Focused Ultrasound Using a Toroidal Transducer Guided by Ultrasound Imaging: The Results of Animal Experiments. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3286-3295. [PMID: 32891425 DOI: 10.1016/j.ultrasmedbio.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 06/11/2023]
Abstract
This study demonstrated that high-intensity focused ultrasound (HIFU) produced with an intra-operative toroidal-shaped transducer causes fast, selective liver tumor ablations in an animal model. The HIFU device is composed of 256 emitters working at 3 MHz. A 7.5 MHz ultrasound imaging probe centered on the HIFU transducer guided treatment. VX2 tumor segments (25 mg) were implanted into the right lateral liver lobes of 45 New Zealand rabbits. The animals were evenly divided into groups 1 (toroidal HIFU ablation), 2 (surgical resection) and 3 (untreated control). Therapeutic responses were evaluated with gross pathology and histology 11 d post-treatment. Toroidal transducer-produced HIFU ablation (average ablation rate 10.5 cc/min) allowed fast and homogeneous tumor treatment. Sonograms showed all ablations. VX2 tumors were completely coagulated and surrounded by safety margins without surrounding-organ secondary HIFU lesions. HIFU group tumor volumes at autopsy (39 mm3) were significantly lower than control group volumes (2610 mm3, p < 0.0001). HIFU group tumor metastasis (27%) was lower than resected (33%) and control (67%) group metastasis. Ultrasound imaging, gross pathology and histology results supported these outcomes. HIFU procedures had no complications. Rabbit liver tumor ablation using a toroidal HIFU transducer under ultrasound imaging guidance might therefore be an effective intra-operative treatment for localized liver metastases.
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Affiliation(s)
- Amélie Battais
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
| | - Victor Barrère
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
| | - W Apoutou N'Djin
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
| | - Aurélien Dupré
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
| | - Michel Rivoire
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
| | - David Melodelima
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France.
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40
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Srouji RM, Narayan RR, Boerner T, Buisman FE, Seier K, Gonen M, Balachandran VP, Drebin JA, Jarnagin WR, Kingham TP, Wei A, Kemeny NE, D'Angelica MI. Extrahepatic recurrence rates in patients receiving adjuvant hepatic artery infusion and systemic chemotherapy after complete resection of colorectal liver metastases. J Surg Oncol 2020; 122:1536-1542. [PMID: 32976666 DOI: 10.1002/jso.26221] [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: 09/02/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study investigated the effect of the reduced dose of systemic chemotherapy (SYS) on recurrence patterns in patients receiving adjuvant hepatic artery infusion (HAI) chemotherapy after complete colorectal liver metastases (CRLM) resection. METHODS Patients undergoing complete CRLM resection between 2000 and 2007 were selected from a prospectively maintained database and categorized as receiving SYS or HAI + SYS. Those with pre and/or intraoperative extrahepatic disease, documented death, or recurrence within 30 days of CRLM resection were excluded. Competing risk, Fine and Gray's tests were used to compare SYS versus HAI + SYS for time-to-organ recurrence. RESULTS Of 361 study patients, 153 (42.4%) received SYS and 208 (57.6%) received HAI + SYS. The median follow-up for survivors was 100 (range = 12-185) and 156 months (range = 18-217) for SYS and HAI + SYS, respectively. The 5-year cumulative incidence (CI) of any liver recurrence was greater for those receiving SYS (SYS = 41.9% vs. HAI + SYS = 28.6%, p = .005). The 5-year CI of developing any lung or extrahepatic recurrence for SYS patients was 36.2% and 47.9% compared with 44.5% (p = .242) and 51.7% (p = .551), respectively, in patients receiving HAI + SYS. CONCLUSION Despite the reduced dose of SYS, adjuvant HAI + SYS after CRLM resection is not associated with a significantly increased risk of extrahepatic recurrence.
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Affiliation(s)
- Rami M Srouji
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Surgery, Barnes Jewish Hospital, Washington University, St. Louis, Missouri, USA
| | - Raja R Narayan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Thomas Boerner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Florian E Buisman
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Kenneth Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vinod P Balachandran
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jeffrey A Drebin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alice Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nancy E Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Lin CC, Chen TH, Wu YC, Fang CY, Wang JY, Chen CP, Huang KW, Jiang JK. Taiwan Society of Colon and Rectal Surgeons (TSCRS) Consensus for Cytoreduction Selection in Metastatic Colorectal Cancer. Ann Surg Oncol 2020; 28:1762-1776. [PMID: 32875464 DOI: 10.1245/s10434-020-08914-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/07/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Taiwan has witnessed a surge in the incidence of colorectal cancer (CRC), of which 40-60% metastasize. Continuous updating of cytoreductive strategies in metastatic CRC (mCRC) has contributed to median overall survival reaching 40 months. In this changing scenario, to standardize the approaches across Taiwan, a group of experts from the Taiwan Society of Colon and Rectal Surgeons (TSCRS) convened to establish evidence- and opinion-based recommendations for defining the criteria of "resectability" in mCRC. METHODS Over the course of one-on-one consultations, lasting 30-40 min each, with 30 medical specialists (19 colorectal surgeons, 4 general surgeons, and 7 medical oncologists) from 16 hospitals in Taiwan followed by a 2-h meeting with 8 physician experts (3 general surgeons, 4 colorectal surgeons, and 1 thoracic surgeon), 12 key questions on cytoreduction were addressed. This was further contextualized based on published literature. RESULTS The final consensus includes eight recommendations regarding the criteria for metastasis resection, role of local control treatment in liver potentially resectable patients, management of synchronous liver metastases, approach for peritoneal metastasis, place for resection in multiple-organ metastasis, and general criteria for resectability. CONCLUSIONS mCRC patients undergoing R0 resection have the greatest survival advantage following surgery. Our role as a multidisciplinary team (MDT) should be to treat potentially resectable mCRC patients as rapidly and safely as possible, and achieve R0 resection as far as possible and for as long as possible (continuum of care). This TSCRS consensus statement aims to help build clinical capacity within the MDTs, while making better use of existing healthcare resources.
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Affiliation(s)
- Chun-Chi Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Te-Hung Chen
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan R.O.C
| | - Yu-Chung Wu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chuan-Yin Fang
- Division of Colorectal Surgery, Department of Surgery, Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
| | - Jaw-Yuan Wang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chou-Pin Chen
- Division of Colorectal Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kai-Wen Huang
- Department of Surgery and Hepatitis Research Centre, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jeng-Kai Jiang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Management strategies for patients with advanced rectal cancer and liver metastases using modified Delphi methodology: results from the PelvEx Collaborative. Colorectal Dis 2020; 22:1184-1188. [PMID: 32043753 DOI: 10.1111/codi.15007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
AIM A total of 15-20% of patients with rectal cancer have liver metastases on presentation. The management of these patients is controversial. Heterogeneity in management strategies is considerable, with management often being dependent on local resources and available expertise. METHOD Members of the PelvEx Collaborative were invited to participate in the generation of a consensus statement on the optimal management of patients with advanced rectal cancer with liver involvement. Fifteen statements were created for topical discussion on diagnostic and management issues. Panellists were asked to vote on statements and anonymous feedback was given. A collaborative meeting was used to discuss any nuances and clarify any obscurity. Consensus was considered when > 85% agreement on a statement was achieved. RESULTS A total of 135 participants were involved in the final round of the Delphi questionnaire. Nine of the 15 statements reached consensus regarding the management of patients with advanced rectal cancer and oligometastatic liver disease. Routine use of liver MRI was not recommended for patients with locally advanced rectal cancer, unless there was concern for metastatic disease on initial computed tomography staging scan. Induction chemotherapy was advocated as first-line treatment in those with synchronous liver metastases in locally advanced rectal cancer. In the presence of symptomatic primary disease, a diverting stoma may be required to facilitate induction chemotherapy. Overall, only one-quarter of the panellists would consider simultaneous pelvic exenteration and liver resection. CONCLUSION This Delphi process highlights the diverse treatment of advanced rectal cancer with liver metastases and provides recommendations from an experienced international group regarding the multidisciplinary management approach.
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Shiozawa T, Kikuchi Y, Wakabayashi T, Matsuo K, Takahashi Y, Tanaka K. Body composition as reflected by intramuscular adipose tissue content may influence short- and long-term outcome following 2-stage liver resection for colorectal liver metastases. Langenbecks Arch Surg 2020; 405:757-766. [PMID: 32851433 DOI: 10.1007/s00423-020-01973-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION For many kinds of cancer, body composition and immunonutritional status have been reported to influence postoperative outcome. We assessed their impact on short- and long-term outcome in patients with colorectal liver metastases who underwent 2-stage liver resections. METHODS Short- and long-term outcomes for 47 patients with 2-stage hepatectomies were assessed retrospectively in terms of data obtained before preoperative chemotherapy, before the first hepatectomy, and before the second hepatectomy. RESULTS Although immunonutritional status and body composition did not affect short-term outcome, high intramuscular fat content before the second hepatectomy was a poor prognostic factor for overall survival (HR, 5.829; 95% CI, 1.611-21.090; p = 0.007) and for recurrence-free survival (HR, 2.787; 95% CI, 1.301-5.973; p = 0.008). Patients with high intramuscular fat before the second hepatectomy also showed shorter intervals from recurrence to treatment failure. CONCLUSION Intramuscular fat before the second hepatectomy is an important negative prognosticator in 2-stage liver resection for colorectal liver metastases.
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Affiliation(s)
- Toshimitsu Shiozawa
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan
| | - Yutaro Kikuchi
- Department of Surgery, Division of Hepato-biliary-pancreatic Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.,Departments of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tetsuji Wakabayashi
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan
| | - Kenichi Matsuo
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan.,Department of Surgery, Division of Hepato-biliary-pancreatic Surgery, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Yuki Takahashi
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan
| | - Kuniya Tanaka
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan. .,Department of Surgery, Division of Hepato-biliary-pancreatic Surgery, Teikyo University Chiba Medical Center, Chiba, Japan. .,Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
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Paredes AZ, Hyer JM, Tsilimigras DI, Moro A, Bagante F, Guglielmi A, Ruzzenente A, Alexandrescu S, Makris EA, Poultsides GA, Sasaki K, Aucejo FN, Pawlik TM. A Novel Machine-Learning Approach to Predict Recurrence After Resection of Colorectal Liver Metastases. Ann Surg Oncol 2020; 27:5139-5147. [PMID: 32779049 DOI: 10.1245/s10434-020-08991-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/11/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surgical resection of hepatic metastases remains the only potentially curative treatment option for patients with colorectal liver metastases (CRLM). Widely adopted prognostic tools may oversimplify the impact of model parameters relative to long-term outcomes. METHODS Patients with CRLM who underwent a hepatectomy between 2001 and 2018 were identified in an international, multi-institutional database. Bootstrap resampling methodology used in tandem with multivariable mixed-effects logistic regression analysis was applied to construct a prediction model that was validated and compared with scores proposed by Fong and Vauthey. RESULTS Among 1406 patients who underwent hepatic resection of CRLM, 842 (59.9%) had recurrence. The full model (based on age, sex, primary tumor location, T stage, receipt of chemotherapy before hepatectomy, lymph node metastases, number of metastatic lesions in the liver, size of the largest hepatic metastases, carcinoembryonic antigen [CEA] level and KRAS status) had good discriminative ability to predict 1-year (area under the receiver operating curve [AUC], 0.693; 95% confidence interval [CI], 0.684-0.704), 3-year (AUC, 0.669; 95% CI, 0.661-0.677), and 5-year (AUC, 0.669; 95% CI, 0.661-0.679) risk of recurrence. Studies analyzing validation cohorts demonstrated similar model performance, with excellent model accuracy. In contrast, the AUCs for the Fong and Vauthey scores to predict 1-year recurrence were only 0.527 (95% CI, 0.514-0.538) and 0.525 (95% CI, 0.514-0.533), respectively. Similar trends were noted for 3- and 5-year recurrence. CONCLUSION The proposed clinical score, derived via machine learning, which included clinical characteristics and morphologic data, as well as information on KRAS status, accurately predicted recurrence after CRLM resection with good discrimination and prognostic ability.
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Affiliation(s)
- Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - J Madison Hyer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Amika Moro
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Fabio Bagante
- Department of Surgery, University of Verona, Verona, Italy
| | | | | | | | | | | | - Kazunari Sasaki
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Federico N Aucejo
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. .,Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
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Risk Factors of Positive Resection Margin in Laparoscopic and Open Liver Surgery for Colorectal Liver Metastases. Ann Surg 2020; 275:e213-e221. [DOI: 10.1097/sla.0000000000004077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Höppener DJ, Nierop PMH, Hof J, Sideras K, Zhou G, Visser L, Gouw ASH, de Jong KP, Sprengers D, Kwekkeboom J, Vermeulen PB, Grünhagen DJ, Verhoef C. Enrichment of the tumour immune microenvironment in patients with desmoplastic colorectal liver metastasis. Br J Cancer 2020; 123:196-206. [PMID: 32418992 PMCID: PMC7374625 DOI: 10.1038/s41416-020-0881-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/08/2020] [Accepted: 04/22/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients with resected colorectal liver metastasis (CRLM) who display only the desmoplastic histopathological growth pattern (dHGP) exhibit superior survival compared to patients with any non-desmoplastic growth (non-dHGP). The aim of this study was to compare the tumour microenvironment between dHGP and non-dHGP. METHODS The tumour microenvironment was investigated in three cohorts of chemo-naive patients surgically treated for CRLM. In cohort A semi-quantitative immunohistochemistry was performed, in cohort B intratumoural and peritumoural T cells were counted using immunohistochemistry and digital image analysis, and in cohort C the relative proportions of individual T cell subsets were determined by flow cytometry. RESULTS One hundred and seventeen, 34, and 79 patients were included in cohorts A, B, and C, with dHGP being observed in 27%, 29%, and 15% of patients, respectively. Cohorts A and B independently demonstrated peritumoural and intratumoural enrichment of cytotoxic CD8+ T cells in dHGP, as well as a higher CD8+/CD4+ ratio (cohort A). Flow cytometric analysis of fresh tumour tissues in cohort C confirmed these results; dHGP was associated with higher CD8+ and lower CD4+ T cell subsets, resulting in a higher CD8+/CD4+ ratio. CONCLUSION The tumour microenvironment of patients with dHGP is characterised by an increased and distinctly cytotoxic immune infiltrate, providing a potential explanation for their superior survival.
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Affiliation(s)
- Diederik J Höppener
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Pieter M H Nierop
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joost Hof
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Kostandinos Sideras
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Guoying Zhou
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Lydia Visser
- Department of Pathology and Medical Biology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Annette S H Gouw
- Department of Pathology and Medical Biology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Koert P de Jong
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Dave Sprengers
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jaap Kwekkeboom
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Peter B Vermeulen
- Translational Cancer Research Unit (GZA Hospitals and University of Antwerp), Antwerp, Belgium
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
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Predictive Value of Intraoperative Indocyanine Green Clearance Measurement on Postoperative Liver Function After Anatomic Major Liver Resection. J Gastrointest Surg 2020; 24:1342-1351. [PMID: 31197694 DOI: 10.1007/s11605-019-04262-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 05/06/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the predictive value of measuring indocyanine green (ICG) clearance during intraoperative partial occlusion of liver lobes to be resected on postoperative liver function following major anatomic liver resection. METHODS We prospectively included 46 patients, and 35 patients ultimately underwent anatomic major liver resection. ICG clearance was measured preoperatively and intraoperatively. Intraoperative ICG clearance was measured immediately after selective occlusion of hepatic arterial, portal, and hepatic venous blood flow to the liver lobes to be resected. The albumin-bilirubin (ALBI) grade, albumin-indocyanine green evaluation (ALICE) grade, platelet count, remnant liver volume per kilogram of weight (RLV/kg), and future liver remnant plasma clearance rate of ICG (ICGK-FLR) were measured preoperatively. RESULTS An intraoperative ICG retention at 15 min (I-R15) greater than 13.8% indicates transient posthepatectomy liver failure (PHLF) and Clavien-Dindo > grade I complications. Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) for predicting PHLF and Clavien-Dindo > grade I complications was 0.797 and 0.734, respectively (p = 0.001 and 0.014). Furthermore, an I-R15 greater than 22.7% indicates mid-term PHLF, and the AUC was 0.911 (p < 0.0001). The I-R15 is a better predictor of PHLF than the ALBI grade, ALICE grade, platelet count, RLV/kg, and ICGK-FLR. CONCLUSIONS Intraoperative ICG clearance measurements during partial occlusion of blood flow accurately predict postoperative liver function and could be new criteria for determining the feasibility and safety of anatomic major liver resection.
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Kobayashi S, Beppu T, Honda G, Yamamoto M, Takahashi K, Endo I, Hasegawa K, Kotake K, Itabashi M, Hashiguchi Y, Kotera Y, Sakamoto K, Yamaguchi T, Morita S, Tabuchi K, Miyazaki M, Sugihara K. Survival Benefit of and Indications for Adjuvant Chemotherapy for Resected Colorectal Liver Metastases-a Japanese Nationwide Survey. J Gastrointest Surg 2020; 24:1244-1260. [PMID: 31197683 DOI: 10.1007/s11605-019-04250-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 04/24/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The survival benefit of and indications for adjuvant chemotherapy (AC) for colorectal liver metastases (CRLM) remain unclear. METHODS Patients who were diagnosed with liver-limited CRLM between 2005 and 2007 and subsequently underwent R0 resection without preoperative chemotherapy were identified in a Japanese nationwide survey. This overall cohort was divided into synchronous and metachronous CRLM cohorts. In each of the three cohorts, the patients that were given AC were matched with those treated with surgery alone via 1:1 propensity score (PS) matching. Recurrence-free survival (RFS) and overall survival (OS) after the initial hepatectomy were compared. RESULTS The median follow-up period was 79.4 months and the overall, synchronous, and metachronous cohorts included 1145, 498, and 647 patients, respectively. After the PS matching, the patients' demographics were well balanced. AC was effective in terms of both RFS and OS in the overall cohort (RFS hazard ratio [HR] 0.784, p = 0.045; OS HR 0.716, p = 0.028) and synchronous cohort (RFS HR 0.677, p = 0.027; OS HR 0.642, p = 0.036), whereas AC was not effective in the metachronous cohort (RFS HR 0.875, p = 0.378; OS HR 0.881, p = 0.496). However, in the metachronous cohort, AC was effective in terms of OS in the subgroup that exhibited disease-free intervals of ≤ 1 year after primary tumor resection (RFS HR 0.667, p = 0.068; OS HR 0.572, p = 0.042). CONCLUSION Adjuvant chemotherapy has a survival benefit for patients with resected CRLM. Synchronous CRLM is a favorable indication for AC, whereas in metachronous CRLM, the use of AC should be individualized according to each patient's risk factors.
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Affiliation(s)
- Shin Kobayashi
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toru Beppu
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan
| | - Goro Honda
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Gastroenterological Surgery, New Tokyo Hospital, Chiba, Japan
| | - Masakazu Yamamoto
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Keiichi Takahashi
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan. .,Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 1138677, Japan.
| | - Itaru Endo
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Gastrointestinal Surgery, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Kiyoshi Hasegawa
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Surgery, Graduate School of Medicine Hepato-Biliary-Pancreatic Surgery Division, University of Tokyo, Tokyo, Japan
| | - Kenjiro Kotake
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Surgery, Sano City Hospital, Tochigi, Japan
| | - Michio Itabashi
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yojiro Hashiguchi
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshihito Kotera
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Sakamoto
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Surgery, Ehime University Hospital, Ehime, Japan
| | - Tatsuro Yamaguchi
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 1138677, Japan
| | - Satoshi Morita
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Tabuchi
- The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan.,Department of Pediatrics, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Masaru Miyazaki
- Mita Hospital, International University of Health and Welfare, Tokyo, Japan
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Du Pasquier C, Roulin D, Bize P, Sempoux C, Rebecchini C, Montemurro M, Schäfer M, Halkic N, Demartines N. Tumor response and outcome after reverse treatment for patients with synchronous colorectal liver metastasis: a cohort study. BMC Surg 2020; 20:78. [PMID: 32306936 PMCID: PMC7169034 DOI: 10.1186/s12893-020-00738-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 04/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The reverse treatment of patients with synchronous colorectal liver metastases (CRLM) is a sequential approach with systemic chemotherapy first, followed by liver resection, and finally, primary tumor resection. The aim of this study was to assess the feasibility, the radiological and pathological tumor response to neoadjuvant therapy, recurrence rates and long-term survival after reverse treatment in a cohort study. METHODS Data from patients with CRLM who underwent a reverse treatment from August 2008 to October 2016 were extracted from our prospective hepato-biliary database and retrospectively analyzed for response rates and survival outcomes. Radiological tumor response was assessed by RECIST (Response Evaluation Criteria In Solid Tumor) criteria and pathological response according to TRG (Tumor Regression Grade). Disease-free and overall survival were estimated with Kaplan-Meier survival curves. RESULTS There were 44 patients with 19 rectal and 25 colonic tumors. The reverse treatment was fully completed until primary tumor resection in 41 patients (93%). Radiological assessment after chemotherapy showed 61% of complete/partial response. Pathological tumor response was major or partial in 52% of patients (TRG 1-3). Median disease-free survival after primary tumor resection was 10 months (95% CI 5-15 months). Disease-free survival at 3 and 5 years was 25% and 25%, respectively. Median overall survival was 50 months (95% CI 42-58 months). Overall survival at 3 and 5 years was 59% and 39%, respectively. CONCLUSION The reverse treatment approach was feasible with a high rate of patients with complete treatment sequence and offers promising long-term survival for selected patients with advanced simultaneous colorectal liver metastases.
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Affiliation(s)
- Céline Du Pasquier
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Department of Pathology, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Didier Roulin
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Department of Pathology, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Pierre Bize
- Department of Radiology, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Christine Sempoux
- Department of Pathology, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Caterina Rebecchini
- Department of Pathology, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Michael Montemurro
- Department of Medical Oncology, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Line PD, Ruffolo LI, Toso C, Dueland S, Nadalin S, Hernandez-Alejandro R. Liver transplantation for colorectal liver metastases: What do we need to know? Int J Surg 2020; 82S:87-92. [PMID: 32305529 DOI: 10.1016/j.ijsu.2020.03.079] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/16/2020] [Accepted: 03/31/2020] [Indexed: 12/12/2022]
Abstract
Adenocarcinoma of the colon and rectum (CRC) is the second leading cause of cancer mortality, driven by stage IV disease (Rahib et al., 2014) [1]. While surgical resection of liver metastases has demonstrated a survival advantage, a minority of patients are candidates for resection due to anatomic involvement of disease. Recent advances in liver surgery, chemotherapy, and decision making guided by stratification at the time of presentation has better equipped us to perform aggressive metastasectomies, with resulting improved survival (Fong et al., 1999; Abdalla et al., 2001; Cremolini et al., 2017) [2-4]. As a result, there is a resurgent interest in the concept of total hepatectomy and liver transplantation (LT) for colorectal liver metastases (CRLM). As of this writing, eight prospective clinical trials in six countries are assessing the viability of split or whole LT for CRLM. However, LT for CRLM remains controversial. Recent prospective trials have illustrated the importance of patient selection, and a disciplined respect for tumor biology. Here we present the current status of LT for CRLM, and suggest clinical decision criteria aimed at matching survival benefit comparable to other indications for LT.
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Affiliation(s)
- Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Luis I Ruffolo
- Department of Surgery and Division of Abdominal Transplantation and Hepatobiliary Surgery, University of Rochester Medical Center, Rochester, USA
| | - Christian Toso
- Division of Abdominal Surgery, Department of Surgery, University of Geneva, Geneva, Switzerland
| | - Svein Dueland
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Silvio Nadalin
- Department of General and Transplant Surgery, University Hospital Tübingen, Germany
| | - Roberto Hernandez-Alejandro
- Department of Surgery and Division of Abdominal Transplantation and Hepatobiliary Surgery, University of Rochester Medical Center, Rochester, USA
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