Liver Resection for Colorectal Metastases in Presence of Extrahepatic Disease: Results from an International Multi-institutional Analysis

Pulitanò, Carlo; Bodingbauer, Martin; Aldrighetti, Luca; Jong, Mechteld C. de; Castillo, Federico; Schulick, Richard D.; Parks, Rowan W.; Choti, Michael A.; Wigmore, Stephen J.; Gruenberger, Thomas; Pawlik, Timothy M.

doi:10.1245/s10434-010-1459-4

Cited by 139 publications

(123 citation statements)

References 21 publications

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“…Thus, most studies on this subject revealed that the presence of portal/retroperitoneal lymph node metastases is a strong predictor of poor outcome (21,(29)(30)(31)(32)(33)(34). Although in our study the difference in OS was not statistically significant lower in these patients compared to other locations of extrahepatic disease, they experienced the lowest median survival (13 months) after R0 surgery.…”

Section: Discussioncontrasting

confidence: 68%

“…Gradually, more and more centers specialized in oncologic surgery performed resection of liver metastases and extrahepatic disease in selected patients with CHEHMs (13,21). In present, in LiverMetSurvey (an international registry including more than 26000 patients with CHMs who were scheduled for curative-intent surgery), the 5-year OS rate of patients undergoing resection of hepatic and extrahepatic metastases was 22% (22).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Diaconescu¹,

Alexandrescu²,

Ionel³

et al. 2017

chr

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Introducere: Beneficiul rezecţiei hepatice în cazul metastazelor hepatice şi extrahepatice colorectale (MHEHCR) este încă discutabil. Scopul acestui studiu este de a evalua rezultatele rezecţiei metastazelor hepatice şi extrahepatice efectuate pacienţilor cu MHEHCR într-un centru medical cu un volum mare de intervenţii chirurgicale, atât în sfera chirurgiei hepato-biliare, cât şi în sfera chirurgiei colo-rectale şi de a identifica factorii de prognostic care se corelează cu o supravieţuire îndelungată. Metoda: Studiul este unul retrospectiv şi se bazează pe un lot de 678 de pacienţi consecutivi, cu metastaze hepatice ale cancerului colo-rectal operate într-un singur centru chirurgical, în perioada aprilie 1996 -martie 2016. Dintre aceştia, 73 de pacienţi au prezentat MHEHCR. Analiza univariată a fost efectuată pentru identificarea acelor factori de risc ce influenţează supravieţuirea generală (SG) . Rezultate: Au fost 20 de metastaze extrahepatice localizate la nivelul pediculului hepatic, 20 la nivel peritoneal, 12 la nivel ovarian şi pulmonar, 9 cu alte localizări şi 12 recidive locale. Au fost efectuate 53 de rezecţii curative (RO). Supravieţuirea Original ArticleChirurgia (2017) comparativă între lotul pacienţilor cu MHEHCR şi cel al pacienţilor cu metastaze strict hepatice a arătat o diferenţă semnificativă statistic în favoarea celui de-al doilea lot (p <0,0001), acelaşi rezultat fiind înregistrat şi în prezenţa rezecţiei R0 în cele două loturi (p <0,0001). În grupul MHEHCR, SG a fost semnificativă statistic mai mare la pacienţii care au beneficiat de rezecţie R0 faţă de cei la care rezecţia a fost R1/R2 (p = 0,004). Analiza univariată a identificat trei variabile drept factori de prognostic negativ pentru SG: 4 sau mai multe metastaze hepatice, efectuarea unei hepatectomii majore şi perioada realizării rezecţiei hepatice (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). Localizarea ovariană sau pulmonară a metastazelor extrahepatice este corelată cu cea mai bună rată de supravieţuire dintre toate localizările posibile dar fară a fi semnificativă statistic. Concluzie: La pacienţii cu metastaze hepatice şi extrahepatice concomitente, rezecţia completă (R0) a acestora prelungeşte în mod semnificativ supravieţuirea. Pacienţii cu mai puţin de 4 metastaze hepatice, a căror rezecţie este realizată printr-o hepatectomie minoră sunt cei care beneficiază cel mai mult de pe urma acestei conduite terapeutice onco-chirurgicale agresive.Cuvinte cheie: metastaze hepatice ale cancerului colo-rectal, metastaze extrahepatice, metastaze hepatice şi extrahepatice ale cancerului colo-rectal, rezecţie hepatică, supravieţuire generală, factori de prognostic AbstractBackground: The benefit of hepatic resection in case of concomitant colorectal hepatic and extrahepatic metastases (CHEHMs) is still debatable. The purpose of this study is to assess the results of resection of hepatic and extrahepatic metastases in patients with CHEHMs in a high-volume center for both hepatobiliary and colorectal surgery and to identify progn...

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Diaconescu¹,

Alexandrescu²,

Ionel³

et al. 2017

chr

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show abstract

“…With the advent of improved chemotherapy and the demonstrated safety of major hepatic resections [57,58], combined resection of liver metastases at the time of resection of extra-hepatic disease, or in sequential fashion, has demonstrated improved long-term survival rates [59][60][61][62][63]. Consequently, the presence of extra-hepatic disease alone is no longer an absolute contraindication to surgical therapy; however complete resection with negative margins of both the hepatic and extra-hepatic sites must be achieved [59][60][61][62]64].…”

Section: Pushing the Envelope: Extended Resections For Extra-hepatic mentioning

confidence: 99%

“…Consequently, the presence of extra-hepatic disease alone is no longer an absolute contraindication to surgical therapy; however complete resection with negative margins of both the hepatic and extra-hepatic sites must be achieved [59][60][61][62]64]. In a meta-analysis of over 1,142 patients addressing hepatectomy for CRLM with extra-hepatic disease, median survival was 30 months (range 14-44 months), and four studies reported patients who were able to undergo R0 hepatectomy with complete removal of extra-hepatic disease with 5-year OS of 19-36 % [59].…”

Section: Pushing the Envelope: Extended Resections For Extra-hepatic mentioning

confidence: 99%

Designing Liver Resections and Pushing the Envelope with Resections for Hepatic Colorectal Metastases

Guye

Schoellhammer

Chiu

et al. 2013

Indian J Surg Oncol

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Current concepts in the management of hepatic metastases have changed dramatically over the past two decades. Multidisciplinary therapies including chemotherapy, surgery, and regional therapy have alone and in combination significantly improved the survival of patients with metastatic colorectal cancer. Conditions that were previously considered hopeless and treated merely for palliation can now be approached with curative intent. In this paper, we review the surgical treatment for colorectal cancer liver metastasis (CRLM) and describe a paradigm-shift in the management of complex heretofore-considered unresectable CRLM. Utilizing advanced multidisciplinary treatment strategies has improved the prognosis of patients with stage IV colorectal cancer to the point where we may question whether CRLM are now a chronic disease.

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“…Patients with aortocaval lymph node involvement had the worst OS compared with other EHD sites [Pulitanò et al 2011]. A recent retrospective review of 840 resected patients of whom 185 patients had resectable EHD attempted to identify prognostic factors to help with selection of patients with EHD for surgery.…”

Section: Extrahepatic Diseasementioning

confidence: 99%

What is the optimal neo-adjuvant treatment for liver metastasis?

Haraldsdóttir

Bloomston

et al. 2013

Ther Adv Med Oncol

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Colorectal cancer is the third most common cancer in the Western population and has a 5-year overall survival of 5-10% when metastatic. Approximately 30% of the patients with metastatic colorectal cancer have limited disease apparently isolated to the liver and, if this can be resected, the 5-year overall survival is improved to 30-60%. Therefore, it is important to identify patients who have both resectable disease and those with initially unresectable tumors who can potentially be downsized with chemotherapy to allow resection. First-line doublet chemotherapy regimens lead to response rates of 50-60%, triplet chemotherapy regimens may result in a response rate of up to 70%, and biological agents may add to responses or induce morphologic changes that facilitate disease resection. Surgical advances in recent years have also increased resectability rates and have challenged prior rules of resectability. Local therapies including ablation and radiation, often performed in conjunction with resection, may further aid in control of disease. The aim of this article is to focus on the role of neoadjuvant therapy in the treatment of colorectal liver metastases.

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Liver Resection for Colorectal Metastases in Presence of Extrahepatic Disease: Results from an International Multi-institutional Analysis

Abstract: Concurrent resection of hepatic and EHD in well-selected patients may provide the possibility of long-term survival. The risk of recurrence, however, remains high, and a worse outcome is associated with both number of metastases and location of EHD.

Cited by 139 publications

References 21 publications

Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Designing Liver Resections and Pushing the Envelope with Resections for Hepatic Colorectal Metastases

What is the optimal neo-adjuvant treatment for liver metastasis?

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