Interval Hepatic Resection of Colorectal Metastases Improves Patient Selection

Lambert, Laura; Colacchio, Thomas A.; Barth, Richard J.

doi:10.1001/archsurg.135.4.473

Cited by 119 publications

(45 citation statements)

References 18 publications

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“…However, at present, staged resections with initial resection of the primary tumor followed by hepatic resection have been frequently performed in patients with SCLM for several reasons 4,5,9,10. First, the perioperative risk of staged resections has been thought to be less than that of simultaneous resection 4,13,14.…”

Section: Discussionmentioning

confidence: 99%

“…Second, staged resections might offer a chance to evaluate liver or extrahepatic metastases between the two operations. Lambert et al reported that staged resections of synchronous hepatic metastases with an interval of 3 to 6 months might allow occult disease to become clinically detectable and could potentially identify patients for whom a hepatic resection would offer no survival benefit 10. Fujita recommended an interval resection to assess the metastatic status of the regional lymph nodes, because the presence of six or more lymph node metastases was an independent poor prognostic factor in patients with resected SCLM and a relative contraindication for hepatic resection 9.…”

Section: Discussionmentioning

confidence: 99%

“…However, several papers reported that the morbidity rate after simultaneous resection of primary and liver tumors was high because of greater surgical stress and a longer operation time than for single-organ surgery. Staged resection with initial operation for the primary lesion followed by resection of hepatic tumors is regarded as an alternative strategy to avoid excessive surgical stress for patients with SCLM, though the efficacy of this strategy and the patients who could benefit from this strategy are unknown 4–6,9,10…”

Section: Introductionmentioning

confidence: 99%

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Predictive Factors for Anastomotic Leakage after Simultaneous Resection of Synchronous Colorectal Liver Metastasis

Takahashi

Saitô

Kotaka³

et al. 2012

Journal of Gastrointestinal Surgery

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BackgroundThe optimal surgical strategy for resectable, synchronous, colorectal liver metastases remains unclear. The objective of this study was to determine which patients could benefit from staged resections instead of simultaneous resection by identifying predictive factors for postoperative morbidity and anastomotic leakage after simultaneous resection of synchronous, colorectal liver metastases and the primary colorectal tumor.MethodsThis study involved 86 patients with synchronous colorectal liver metastases who underwent simultaneous resection of the primary colorectal tumor and the hepatic tumor. Postoperative mortality, morbidity, and other surgical outcomes, including survival and hospitalization, were assessed. Predictive factors for postoperative morbidity and for anastomotic leakage were evaluated.ResultsPostoperative morbidity and anastomotic leakage were found in 55 (64%) and 18 (21%) patients. Predictive factors for postoperative morbidity and for anastomotic leakage were intraoperative blood loss and operation time >8 h, respectively. The overall 5-year survival rate was 45%.ConclusionsThe frequency of morbidity and that of anastomotic leakage seemed to be high after simultaneous resection for synchronous colorectal liver metastases, especially when intraoperative blood loss or operation time increased greatly. Staged resections should be considered in cases in which excessive surgical stress from simultaneous resection of synchronous colorectal liver metastases would be expected.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictive Factors for Anastomotic Leakage after Simultaneous Resection of Synchronous Colorectal Liver Metastasis

Takahashi

Saitô

Kotaka³

et al. 2012

Journal of Gastrointestinal Surgery

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“…When compared with surgical resection, RF ablation is less invasive, less expensive, and has fewer contraindications. Moreover, since many patients will develop liver metastases after surgery, the test-of-time approach, which has already been proposed for colon cancer liver metastases (53,54), could be used in patients with breast cancer liver metastases. This approach would help avoid unnecessary surgery in patients who would develop new metastases.…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer Liver Metastases: US-guided Percutaneous Radiofrequency Ablation—Intermediate and Long-term Survival Rates

Meloni

Andreano²,

Laeseke³

et al. 2009

Radiology

122

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Purpose To retrospectively assess the local control and intermediate- and long-term survival of patients with liver metastases from breast cancer who have undergone percutaneous ultrasonography (US)-guided radiofrequency (RF) ablation. Materials and Methods This study was approved by the hospital ethics committee, and all patients provided written informed consent. RF ablation was used to treat 87 breast cancer liver metastases (mean diameter, 2.5 cm) in 52 female patients (median age, 55 years). Inclusion criteria were as follows: fewer than five tumors, maximum tumor diameter of 5 cm or smaller, and disease either confined to the liver or stable with medical therapy. Forty-five (90%) of 50 patients had previously undergone chemotherapy, hormonal therapy, or both, and had no response or an incomplete response to the treatment. Contrast material–enhanced computed tomography and US were performed to evaluate complications and technical success and to assess for local tumor progression during follow-up. The Kaplan-Meier method was used to assess survival, and results were compared between groups with a log-rank test. Cox regression analysis was used to assess independent prognostic factors that affected survival. Results Complete tumor necrosis was achieved in 97% of tumors. Two (4%) minor complications occurred. Median time to follow-up from diagnosis of liver metastasis and from RF ablation was 37.2 and 19.1 months, respectively. Local tumor progression occurred in 25% of patients. New intrahepatic metastases developed in 53% of patients. From the time of first RF ablation, overall median survival time and 5-year survival rate were 29.9 months and 27%, respectively. From the time the first liver metastasis was diagnosed, overall median survival time was 42 months, and the 5-year survival rate was 32%. Patients with tumors 2.5 cm in diameter or larger had a worse prognosis (hazard ratio, 2.1) than did patients with tumors smaller than 2.5 cm in diameter. Conclusion Survival rates in selected patients with breast cancer liver metastases treated with RF ablation are comparable to those reported in the literature that were achieved with surgery or laser ablation.

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“…The classical approach is to resect the primary colorectal tumor first, and then to proceed with liver resection after 2-3 months, with chemotherapy in the interim. This policy enables the selection of the best candidates for surgery (12). With improvements in surgical techniques worldwide, the safety and efficacy of the simultaneous resection of colorectal and liver tumors has been confirmed (14-16).…”

Section: Introductionmentioning

confidence: 99%

Simultaneous hepatic resection benefits patients with synchronous colorectal cancer liver metastases

Li¹,

Bi²,

Zhao³

et al. 2016

Chinese Journal of Cancer Research

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Objective The safety of the simultaneous resection of synchronous colorectal cancer liver metastases (SCRLM) is still being debated. However, this simultaneous operative approach is more commonly adopted at present than in the past. Therefore, we compared simultaneous hepatic resection with delayed hepatic resection in this study.Methods All patients with SCRLM diagnosed before initial treatment between January 2009 and September 2013 were retrospectively included in our study. Short-term and long-term outcomes were compared in patients who underwent simultaneous colorectal and hepatic resection and those treated by delayed hepatectomy.Results Among the 73 patients diagnosed with SCRLM, simultaneous colorectal and hepatic resection was performed in 60 patients (82.2%), while delayed hepatic resection was performed in 13 patients (17.8%). The mortality rate was zero. The postoperative complication rate after delayed resection was higher than, but not significantly different from, that after simultaneous resection (46% vs. 23%, P=0.166). The duration of operating time (240 vs. 420 min, P<0.05) and postoperative hospital stay time (11 vs. 18 days, P<0.05) were shorter in the simultaneous resection group. After the initial treatments were given, the 1-, 2-, and 3-year survival rates in the simultaneous resection group were 77%, 59%, and 53%, respectively, whereas those in the delayed resection group were 67%, 42%, and 10%, respectively. The 5-year survival rate in the simultaneous resection group was 23%; overall survival differed significantly between the two groups (P=0.037). Median disease-free survival (DFS) times were 19.1 months in the simultaneous resection group and 8.8 months in the delayed resection group. DFS differed significantly between the two groups.Conclusions Simultaneous colorectal and hepatic resection is safe and exhibits advantages in the long-time survival of patients.

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Interval Hepatic Resection of Colorectal Metastases Improves Patient Selection

Cited by 119 publications

References 18 publications

Predictive Factors for Anastomotic Leakage after Simultaneous Resection of Synchronous Colorectal Liver Metastasis

Predictive Factors for Anastomotic Leakage after Simultaneous Resection of Synchronous Colorectal Liver Metastasis

Breast Cancer Liver Metastases: US-guided Percutaneous Radiofrequency Ablation—Intermediate and Long-term Survival Rates

Simultaneous hepatic resection benefits patients with synchronous colorectal cancer liver metastases

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