Nonresponse to pre-operative chemotherapy does not preclude long-term survival after liver resection in patients with colorectal liver metastases

Neumann, Ulf; Thelen, Armin; Röcken, Christoph; Seehofer, Daniel; Bahra, Marcus; Riess, Hanno; Jonas, Sven; Schmeding, Maximilian; Pratschke, Johann; Bova, Roberta; Neuhaus, P.

doi:10.1016/j.surg.2009.02.004

Cited by 45 publications

(29 citation statements)

References 32 publications

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“…8,42 Response to preoperative treatment is reported to be associated with improved outcomes, 43 although some denied this finding. 44 In addition, disease progression following PVE is suggested to be due to aggressive tumor biology rather than an effect of PVE. 42 This suggests that patients reaching resection after PVE have favorable tumor biology.…”

Section: Discussionmentioning

confidence: 99%

Oncological Outcomes of Major Liver Resection Following Portal Vein Embolization: A Systematic Review and Meta-analysis

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Oncological Outcomes of Major Liver Resection Following Portal Vein Embolization: A Systematic Review and Meta-analysis

et al. 2016

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“… Notes: aSummary of median survival reported or estimated from the studies included, see methods for details on estimation;bincludes three studies of patients with preoperative chemotherapy only (Gallagher et al,111 Kishi et al,123 Neumann et al84);cincludes studies that compared preoperative chemotherapy to no preoperative chemotherapy only;done study in synchronous patient populations only (de Santibañes et al105). …”

Section: Figurementioning

confidence: 99%

Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors

Kanas¹,

Taylor²,

Primrose³

et al. 2012

CLEP

343

225

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BackgroundHepatic metastases develop in approximately 50% of colorectal cancer (CRC) cases. We performed a review and meta-analysis to evaluate survival after resection of CRC liver metastases (CLMs) and estimated the summary effect for seven prognostic factors.MethodsStudies published between 1999 and 2010, indexed on Medline, that reported survival after resection of CLMs, were reviewed. Meta-relative risks for survival by prognostic factor were calculated, stratified by study size and annual clinic volume. Cumulative meta-analysis results by annual clinic volume were plotted.ResultsFive- and 10-year survival ranged from 16% to 74% (median 38%) and 9% to 69% (median 26%), respectively, based on 60 studies. The overall summary median survival time was 3.6 (range: 1.7–7.3) years. Meta-relative risks (95% confidence intervals) by prognostic factor were: node positive primary, 1.6 (1.5–1.7); carcinoembryonic antigen level, 1.9 (1.1–3.2); extrahepatic disease, 1.9 (1.5–2.4); poor tumor grade, 1.9 (1.3–2.7); positive margin, 2.0 (1.7–2.5); >1 liver metastases, 1.6 (1.4–1.8); and >3 cm tumor diameter, 1.5 (1.3–1.8). Cumulative meta-analyses by annual clinic volume suggested improved survival with increasing volume.ConclusionThe overall median survival following CLM liver resection was 3.6 years. All seven investigated prognostic factors showed a modest but significant predictive relationship with survival, and certain prognostic factors may prove useful in determining optimal therapeutic options. Due to the increasing complexity of surgical interventions for CLM and the inclusion of patients with higher disease burdens, future studies should consider the potential for selection and referral bias on survival.

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“…Another argument in favor of the reverse strategy, by applying chemotherapy first, is to select patients in whom curative treatment could still be attempted -independently of the number and size of liver lesions -and avoid the subsequent steps of aggressive treatment in poor responders [34] who would most likely benefit from palliative management only. If, in fact, following this concept, before the liver step, on patients who are poor responders or not responders, no resections are performed, nonuseful operations and complications will be avoided [24,35]; even if this concept is denied by other authors [36,37], who think that tumor progression after neoadjuvant chemotherapy does not preclude subsequent surgical attempt of resection. Of course bilateral liver metastases seems to be a limit for the simultaneous approach given that associating a major liver resection with a colorectal resection is linked to a higher mortbility and mortality rate [38].…”

Section: Surgical Strategies In Colorectal Cancermentioning

confidence: 99%

‘Liver-First’ Approach for Metastatic Colorectal Cancer

et al. 2015

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The liver-first approach was proposed for the first time in 2006 to obtain resectability of stage IV colorectal cancer patients and complete the therapeutic plan. From then some groups have used this new revolutionary approach reporting promising results. Other alternative strategies have been proposed for metastatic patients. The authors reviewed the literature weighing the pros and cons of each strategy proposed to manage these advanced tumor stages. The therapeutic options are analyzed in the light of oncologic problems and evidence. Also problems, questions and perspectives are given. Even if the 'liver-first' approach seems to be a promising strategy, the ideal diagnostic-therapeutic flowchart for metastatic colorectal cancer is still difficult to standardize. The great heterogeneity of this population of patients is one of the main problems. A 'tailored approach' philosophy is necessary to calibrate, in a multidisciplinary setting, a case-by-case choice of therapeutic options.

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Nonresponse to pre-operative chemotherapy does not preclude long-term survival after liver resection in patients with colorectal liver metastases

Cited by 45 publications

References 32 publications

Oncological Outcomes of Major Liver Resection Following Portal Vein Embolization: A Systematic Review and Meta-analysis

Oncological Outcomes of Major Liver Resection Following Portal Vein Embolization: A Systematic Review and Meta-analysis

Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors

‘Liver-First’ Approach for Metastatic Colorectal Cancer

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