Management of liver metastases in colorectal cancer patients: A retrospective case-control study of systemic therapy versus liver resection

Ridder, J.A.M. de; Stok, Eric P. van der; Mekenkamp, L.; Wiering, Bastiaan; Koopman, Miriam; Punt, Cornelis J.A.; Verhoef, Cornelis; Wilt, Johannes H. de

doi:10.1016/j.ejca.2016.02.003

Cited by 51 publications

(37 citation statements)

References 42 publications

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“…At diagnosis, resectability is gauged on tumor burden, location, and size of metastases and adequacy of the future liver remnant. While systemic therapy offers a median overall survival of 26.5 months at best, case-matched patients undergoing metastatectomy have a significantly higher 56-month overall survival [5]. Thus, where possible, metastatic resection is advisable in order to achieve optimum survival rates.…”

Section: Discussionmentioning

confidence: 99%

“…Without treatment, median overall survival for patients with CRLM is 8 months [1]; this prognosis worsens where there is both liver and extrahepatic disease (EHD). Current chemotherapeutic regimens can prolong survival in patients with CRLM and EHD to 26.5 months, but best evidence dictates superior outcomes if surgical resection is performed [2-5]. Extension of hepatic metastatic disease to involve adjacent viscera was traditionally a contraindication to resectability.…”

Section: Introductionmentioning

confidence: 99%

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Multivisceral Resection for Locally Invasive Colorectal Liver Metastases: Outcomes of a Matched Cohort Analysis

et al. 2018

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Local invasion of adjacent viscera by colorectal liver metastases (CRLM) is no longer considered an absolute contraindication to curative hepatic resection. A growing number of observational analyses have illustrated the feasibility of such resections; however, the evidence base is at best heterogeneous with a lack of evidence comparing similar patient groups. We aimed to evaluate the outcomes of hepatectomy for CRLM when combined with other viscera and compare to a matched cohort of isolated hepatic resections. Methods: From 2005 to 2015, 523 patients underwent hepatic resection for CRLM at our institution, 19 of whom underwent hepatectomy with extrahepatic resection. A 3: 1 matched cohort analysis was performed between those who underwent isolated hepatectomy (control group) and those who underwent hepatectomy with extrahepatic resection (combined group). Clinicopathological data were reviewed along with 30-day postoperative morbidity and mortality. Furthermore, overall survival for the multivisceral cohort was compared to all other isolated hepatectomies over the same time period. Results: Nineteen patients underwent liver resection accompanied by either/or diaphragmatic resection (n = 13), major vein resection and reconstruction (n = 5), and visceral resection (n = 3). Maximum tumor size was significantly larger in the combined group (60.58 vs. 15.34 mm p < 0.0001). Postoperative morbidity was similar in both groups (p = 0.41). Following multivisceral resection, 1-, 3- and 5-year survival rates were 75, 56.6, and 25.7% respectively. Overall survival showed no significant difference between combined and control groups (p = 0.78). Similarly, when compared to the total cohort of isolated liver resections (n = 504), no significant difference in overall mortality was noted. Conclusion: In patients presenting with concomitant CRLM and extrahepatic extension where R0 margins can be achieved, this present study supports the rationale to proceed to surgery with comparable morbidity and mortality rates to isolated hepatectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multivisceral Resection for Locally Invasive Colorectal Liver Metastases: Outcomes of a Matched Cohort Analysis

et al. 2018

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“…Hepatic resection is considered to be the only potentially curative treatment of colorectal liver metastases (CRLM) [1]. With the increased use of new oncological, surgical and ablative treatments, the indications for surgery have expanded, and about 25% of CRLM patients are offered liver resection today.…”

Section: Introductionmentioning

confidence: 99%

Heterogeneous radiological response to neoadjuvant therapy is associated with poor prognosis after resection of colorectal liver metastases

Brunsell

Cengija

Sveen

et al. 2019

European Journal of Surgical Oncology

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a b s t r a c tIntroduction: Surgery combined with perioperative chemotherapy has become standard of care in patients with resectable colorectal liver metastases. However, poor outcome is expected for a significant subgroup. The clinical implications of inter-metastatic heterogeneity remain largely unknown. In a prospective, population-based series of patients undergoing resection of multiple colorectal liver metastases, the aim was to investigate the prevalence and prognostic impact of heterogeneous response to neoadjuvant chemotherapy. Materials and Methods: Radiological response to treatment was evaluated in a lesion-specific manner in 2e5 metastases per patient. Change of lesion diameter was evaluated and response/progression was classified according to three different size thresholds; 3, 4 and 5 mm. A heterogeneous response was defined as progression and response of different metastases in the same patient. Results: In total, 142 patients with 585 liver metastases were examined with the same radiological method (MRI or CT) before and after neoadjuvant treatment. Heterogeneous response to treatment was seen in 16 patients (11%) using the 3 mm size change threshold, and this group had a 5-year cancerspecific survival of 19% compared to 49% for patients with response in all lesions (p ¼ 0.003). Cut-off values of 4e5 mm were less sensitive for detecting a heterogeneous response, but the survival difference was similar and significant. Conclusion: A subgroup of patients with multiple colorectal liver metastases had heterogeneous radiological response to neoadjuvant chemotherapy and poor prognosis. The evaluation of response pattern is easy to perform, feasible in clinical practice and, if validated, a promising biomarker for treatment decisions.

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“…Surgery for colon cancer with liver metastasis is a critical and controversial issue and continues to this day. Though most researchers believe that completed resection of both of primary and metastatic lesions would provide a survival advantage than systemic therapy, the mainly dispute is whether palliative resection of part of lesions is bene t for patients, especially resection only to primary colon cancer or liver metastasis [27]. What's more, systemic chemotherapy, molecular targeted therapy, immunotherapy, portal vein or hepatic artery embolization and radiofrequency ablation play a gradually more important role in mCC treatment, which might provide a potentially longer survival and downstaging of tumor [5,23,27,28].…”

Section: Discussionmentioning

confidence: 99%

Surgery improves the prognosis of colon mucinous adenocarcinoma with liver metastases: A SEER-Based Study

Huang

Chen

Liu

et al. 2020

Preprint

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Background: Mucinous adenocarcinoma (MC) is the second most common pathological type of colon carcinoma (CC). Colon cancer liver metastases (CLMs) are common and lethal, and complete resection of the primary tumour and metastases for CLM patients would be beneficial. However, there is still no consensus on the role of surgery for MC with liver metastases (M-CLM). Methods: Patients diagnosed with M-CLM or classical adenocarcinoma with CLM (A-CLM) from 2010 to 2013 in the Surveillance, Epidemiology, and End Results (SEER) database were retrieved. The clinicopathological features and overall survival (OS) and cancer-specific survival (CSS) data were compared and analysed.Results: The results showed that the M-CLM group had a larger tumour size, more right colon localizations, higher pT and pN stages, more female patients, and more retrieved and positive lymph nodes and accounted for a higher proportion of surgeries than the A-CLM group. The OS and CSS of M-CLM patients who underwent any type of surgery were significantly better than those of patients who did not undergo any surgery, but poorer than those of A-CLM patients who underwent surgery. Meanwhile, the OS and CSS of M-CLM and A-CLM patients who did not undergo any surgery were comparable. Compared with hemicolectomy, partial colectomy led to similar or better OS and CSS for M-CLM, and surgery was an independent protective factor for long-term survival in M-CLM.Conclusions: M-CLM had distinct clinicopathological characteristics from A-CLM, and surgery could improve the long-term survival and is an independent favourable prognostic factor for M-CLM. In addition, partial colectomy might be a better choice than hemicolectomy for M-CLM according to the results from this study.

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Management of liver metastases in colorectal cancer patients: A retrospective case-control study of systemic therapy versus liver resection

Cited by 51 publications

References 42 publications

Multivisceral Resection for Locally Invasive Colorectal Liver Metastases: Outcomes of a Matched Cohort Analysis

Multivisceral Resection for Locally Invasive Colorectal Liver Metastases: Outcomes of a Matched Cohort Analysis

Heterogeneous radiological response to neoadjuvant therapy is associated with poor prognosis after resection of colorectal liver metastases

Surgery improves the prognosis of colon mucinous adenocarcinoma with liver metastases: A SEER-Based Study

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