Management of colon cancer in patients with cirrhosis: A review

Sabbagh, Charles; Cossé, Cyril; Chauffert, Bruno; Nguyen‐Khac, Eric; Joly, Jean‐Paul; Yzet, T.; Régimbeau, Jean-Marc

doi:10.1016/j.suronc.2015.06.010

Cited by 16 publications

(12 citation statements)

References 39 publications

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“…Further studies with a large number of patients are needed to verify the safety and efficacy of chemotherapy in these patents. In addition, there are little data on chemotherapy for liver cirrhosis patients because such patients are generally excluded from analysis in randomized controlled trials [20, 21]. A previous study recommended taking into account liver-related and tumor-related prognoses when considering treatment for patients with life expectancies ≥3 months [22].…”

Section: Discussionmentioning

confidence: 99%

Oncologic and surgical outcomes in colorectal cancer patients with liver cirrhosis: A propensity-matched study

et al. 2017

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The management of colorectal cancer in patients with liver cirrhosis requires a thorough understanding of both diseases. This study evaluated the effect of liver cirrhosis on oncologic and surgical outcomes and prognostic factors in colorectal cancer patients. Fifty-five consecutive colorectal cancer patients with liver cirrhosis underwent colorectal resection (LC group). Using a prospectively maintained database, these patients were matched 1:4 using propensity scoring with R programming language, package "MatchIt" and "optmatch" by sex, age, cancer location, and tumor stage with 220 patients without liver cirrhosis (non-LC group), resulting in 275 patients. The 5-year overall survival (OS) was significantly worse in the LC group than in the non-LC group (46.7% vs. 76.2% respectively, P < 0.001); however, the 5-year proportion of recurrence free (PRF) rates were similar (73.1% vs. 84.5% respectively, P = 0.094). On multivariate analysis of the LC group, tumor-node-metastasis (TNM) stage ≥III disease, venous invasion, and a model for end-stage liver disease plus serum sodium (MELD-Na) score >10 were prognostic factors for OS. However, the OS was not different between the LC group with MELD-Na score ≤10 and the non-LC group (5-year OS rate, TNM stage ≤II, 85.7 vs 89.5%, p = 0.356; TNM stage ≥III, 41.1 vs 66.2%, p = 0.061). Colorectal cancer patients with liver cirrhosis have poorer OS compared to those without liver cirrhosis; however, the PRF rates are similar. It might be due to the mortality from the liver, and surgical treatment should be actively considered for patients with MELD-Na score <10.

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Section: Discussionmentioning

confidence: 99%

Oncologic and surgical outcomes in colorectal cancer patients with liver cirrhosis: A propensity-matched study

et al. 2017

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“…The present study aims to raise awareness upon the risks of colorectal surgery in cirrhotic patients, showing that operating on these patients might not always be such a stumbling rock (21). Particularly, Child A patients can generally be considered to be no different that the non-cirrhotic population (22). Even though statistically this could not be confirmed, this is only due to the fact that in terms of post-operative complications Child A patients besides wound infections, which is a general complication, develop ascites additionally in a small percentage.…”

Section: Discussionmentioning

confidence: 97%

The Outcome of Colorectal Surgery in Cirrhotic Patients: A Case Match Report

Lacatus¹,

Costin²,

Bodean³

et al. 2018

chr

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Introducere: Chirurgia colorectală la pacientul cirotic a reprezentat dintotdeauna un subiect controversat, având indicaţii limitate. Însă, aşa cum şi studiul îşi propune să demonstreze, evaluarea atentă a factorilor de risc poate să extindă aceste indicaţii. Pacienţi şi metodă: În perioada ianuarie 2011-ianuarie 2016, în Clinica de Chirurgie Generală şi Transplant Hepatic din cadrul Institutului Clinic Fundeni, au fost operaţi 68 de pacienţi cu cancer colorectal şi ciroza hepatică. Lotul a fost comparat cu 136 de pacienţi cu neoplasm de colon sau rect, însă fără suferinţă hepatică. În acest sens au fost evaluaţi factorii de risc, morbiditatea şi mortalitatea. Rezultate: Factori de risc specifici precum stadiul afecţiunii hepatice (scorul Child, MELD), etiologia bolii, gradul de hipoalbuminemie şi prezenţa ascitei, precum şi vârsta pacienţilor influenţează evoluţia postoperatorie. Rata de reintervenţie a fost mai mare în grupul cirotic fiind influenţată de tipul operaţiei, metoda de abord şi nivelul de urgenţă (10.2% vs. 5.1%). Morbiditatea înregistrată în grupul pacienţilor cirotici a fost mai mare faţă de lotul martor 47.1% vs. 27.9% (p=0.035); aceeaşi tentinţă a fost observată şi în cazul mortalităţii 5.9% vs. 2.2%. (p=0.2). Pacienţii din grupul Child C au înregistrat procente mari de morbiditate şi mortalitate, 75 % respectiv 50%. Concluzie: Pacienţii cu ciroză Child A pot fi trataţi chirurgical, fără riscuri adiţionale faţă de populaţia generală. Grupul Child B necesită evaluare preoperatorie atentă, iar cei din Child C vor fi abordaţi mai degrabă conservator.

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“…The same agents used alone can cause hepatic SOS/VOD. At doses of oxaliplatin used for colon carcinoma therapy, patients with advanced cirrhosis are at increased risk for hepatic decompensation [41].…”

Section: Role Of Endothelial Cell Injurymentioning

confidence: 99%

The Role of Vascular Injury and Congestion in the Pathogenesis of Cirrhosis: the Congestive Escalator and the Parenchymal Extinction Sequence

Wanless

2020

Curr Hepatology Rep

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Purpose of Review Current research into the pathogenesis of cirrhosis is largely dominated by investigations of hepatocellular injury and fibrogenesis, mostly in short-term experimental models. Cirrhosis in the human evolves for decades with histologic features that are very different from the models studied, dominated by hepatic vein obstruction and congestion. This is a clue that the mechanisms operating in the human are different from those in most animal models. Recent Findings This paper presents an updated "vascular hypothesis" with previously unpublished observations that provide a more complete understanding of the pathogenesis of chronic liver disease in the human: (1) a definition of parenchymal extinction emphasizing the importance of sinusoidal destruction, (2) analysis of the temporal evolution of parenchymal extinction lesions, (3) new data to quantify hepatic vein obstruction, (4) a "congestive escalator" hypothesis to explain how vascular obstruction occurs, beginning with sinusoidal endothelial cell injury, fluid translocation, and vascular compression by mechanics known as "compartment syndrome," (5) a "nested cone model" of hepatic vein anatomy that predisposes to compartment syndrome in the human, and (6) a proposal for the mechanism of collagen formation in response to congestion ("congestive fibrosis"). Summary The guiding principle in this model is that flow has to be vented to keep pressure gradients within the physiological range. Vascular obstruction causes tissue congestion which induces further vascular obstruction that drives a congestive escalator leading to progressive parenchymal extinction. This model may be applicable to all types of cirrhosis found in the human.

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Management of colon cancer in patients with cirrhosis: A review

Cited by 16 publications

References 39 publications

Oncologic and surgical outcomes in colorectal cancer patients with liver cirrhosis: A propensity-matched study

Oncologic and surgical outcomes in colorectal cancer patients with liver cirrhosis: A propensity-matched study

The Outcome of Colorectal Surgery in Cirrhotic Patients: A Case Match Report

The Role of Vascular Injury and Congestion in the Pathogenesis of Cirrhosis: the Congestive Escalator and the Parenchymal Extinction Sequence

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