Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases

Pool, A.E. van der; Wilt, Johannes H. W. de; Lalmahomed, Zarina S.; Eggermont, A. M. M.; IJzermans, Jan N.M.; Verhoef, Cornelis

doi:10.1002/bjs.6947

Cited by 97 publications

(55 citation statements)

References 38 publications

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“…Our patients had a median of 13 metastatic nodules, and all had a bilobar distribution of lesions. This was worse than for subjects of previous reports, whose median metastatic tumor number was 2 to 6 [8,9,11,12,13,15], with 52-71% of patients showing a bilobar distribution [8,10,12,13,14,15]. Further, 2-stage hepatectomy was performed in 0-38% of patients in previous studies [8,9,10,12,13], but was performed in 60% of patients in our study.…”

Section: Discussioncontrasting

confidence: 45%

“…In patients with a large liver tumor burden, one strives to control the disease with downstaging chemotherapy and then consider liver resection first as this possibly can improve long-term survival. The several previous studies of the liver-first approach, [7,9,10,11,12,13,14,15] however, did not focus on patients with heavy liver tumor burdens likely to lead to their death. The median number of metastases was only 2-6, and bilobar metastases were present only in 50-70% of patients.…”

Section: Introductionmentioning

confidence: 99%

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Preliminary Results of ‘Liver-First' Reverse Management for Advanced and Aggressive Synchronous Colorectal Liver Metastases: A Propensity-Matched Analysis

et al. 2015

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Background: Although a ‘liver-first' approach recently has been advocated in treating synchronous colorectal metastases, little is known about how results compare with those of the classical approach among patients with similar grades of liver metastases. Methods: Propensity-score matching was used to select study subjects. Oncologic outcomes were compared between 10 consecutive patients with unresectable advanced and aggressive synchronous colorectal liver metastases treated with the reverse strategy and 30 comparable classically treated patients. Results: Numbers of recurrence sites and recurrent tumors irrespective of recurrence sites were greater in the reverse group then the classic group (p = 0.003 and p = 0.015, respectively). Rates of freedom from recurrence in the remaining liver and of freedom from disease also were poorer in the reverse group than in the classical group (p = 0.009 and p = 0.043, respectively). Among patients treated with 2-stage hepatectomy, frequency of microvascular invasion surrounding macroscopic metastases at second resection was higher in the reverse group than in the classical group (p = 0.011). Conclusions: Reverse approaches may be feasible in treating synchronous liver metastases, but that strategy should be limited to patients with less liver tumor burden.

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Section: Discussioncontrasting

confidence: 45%

Section: Introductionmentioning

confidence: 99%

Preliminary Results of ‘Liver-First' Reverse Management for Advanced and Aggressive Synchronous Colorectal Liver Metastases: A Propensity-Matched Analysis

et al. 2015

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“…Also, blood transfusions increase the recurrent rate in patients treated with liver resection due to malignancy [2,[5][6][7]. Pringle first described the efficacy of vascular occlusion of hepatoduodenal ligament in patients with liver damage in 1908 [8].…”

Section: Discussionmentioning

confidence: 99%

Methods for Vascular Control in Liver Resections Due to Colorectal Metastases - Impact on Residual Parenchyma

Petrovski¹,

Arabadzhieva²,

Bonev³

et al. 2016

Macedonian Medical Review

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Introduction. Massive blood loss while performing resections of the liver continues to be a serious problem with potentially lethal outcome. Therefore in the last 2-3 decades there has been a significant developement of techniques for vascular control during liver resections. Methods. In the period from 01.01.2006 to 31.12.2015 in KOCPH UMBAL "Aleksnadrovska" a total of 239 patients with colorectal liver metastases underwent surgery of whom: 179 patients were radicaly operated on and 57 patients were subjected to Pringle maneuver. Using the statistical software SPSS-19 we analyzed various factors that may affect the early postoperative results. Results. In resections of colorectal liver metastases there was a significant difference in the postoperative functional parameters (AST, ALT), which correlated with the degree of liver damage, in patients with Pringle and without Pringle maneuver 265.32 vs. 448 (p=0.001), and 300.53 vs. 481.91 (p=0.002),-respectively. There was no significant difference in the postoperative results in comparisson of resections <15 minutes, performed without Pringle and with Pringle maneuver. The blood loss is another factor that affects the postoperative complications (p = 0.048), and it was lowest in the Pringle group <15 min. Conclusion. Pringle maneuver is a simple and effecttive method for vascular control. As a result of its use we can observe the damage of the residual liver volume from the continuous ischemia to the reperfusion period. Thus, in liver resections, due to colorectal metastasis, vascular control strategy should be individual and corresponding to the extent of the procedure and associated diseases of the liver-fatty liver, cirrhosis, chronic hepatitis and others.

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“…Complete surgical resection of CRLM improves 5-year survival rates to around 35-60% in selected patients [5][6][7][8]. However in only 10-20% of patients surgical resection of CRLM is feasible.…”

Section: Colorectal Liver Metastases: Surgical Treatmentmentioning

confidence: 99%

Neo-adjuvant chemotherapy followed by surgery versus surgery alone in high-risk patients with resectable colorectal liver metastases: The CHARISMA randomized multicenter clinical trial.

Stok

Verhoef

Grünhagen

2016

JCO

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Neo-adjuvant chemotherapy followed by surgery versus surgery alone in high-risk patients with resectable colorectal liver metastases: the CHARISMA randomized multicenter clinical trial AbstractBackground: Efforts to improve the outcome of liver surgery by combining curative resection with chemotherapy have failed to demonstrate definite overall survival benefit. This may partly be due to the fact that these studies often involve strict inclusion criteria. Consequently, patients with a high risk profile as characterized by Fong's Clinical Risk Score (CRS) are often underrepresented in these studies. Conceptually, this group of patients might benefit the most from chemotherapy. The present study evaluates the impact of neo-adjuvant chemotherapy in high-risk patients with primary resectable colorectal liver metastases, without extrahepatic disease. Our hypothesis is that adding neo-adjuvant chemotherapy to surgery will provide an improvement in overall survival (OS) in patients with a high-risk profile.Methods/Design: CHARISMA is a multicenter, randomized, phase III clinical trial. Patients will be randomized to either surgery alone (standard treatment, arm A) or to 6 cycles of neo-adjuvant oxaliplatin-based chemotherapy, followed by surgery (arm B). Patients must be ≥ 18 years of age with liver metastases of histologically confirmed primary colorectal carcinoma. Patients with extrahepatic metastases are excluded. Liver metastases must be deemed primarily resectable. Only patients with a CRS of 3-5 are eligible. The primary study endpoint is OS. Secondary endpoints are progression free survival (PFS), quality of life, morbidity of resection, treatment response on neo-adjuvant chemotherapy, and whether CEA levels can predict treatment response. Discussion: CHARISMA is a multicenter, randomized, phase III clinical trial that will provide an answer to the question if adding neo-adjuvant chemotherapy to surgery will improve OS in a well-defined high-risk patient group with colorectal liver metastases.Trial registration: The CHARISMA is registered at European Union Clinical Trials Register (EudraCT), number: 2013-004952-39, and in the "Netherlands national Trial Register (NTR), number: 4893.

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Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases

Abstract: Long-term survival can be achieved using an individualized approach, with curative intent, in patients with rectal cancer and synchronous liver metastases. Simultaneous resections as well as the liver-first approach are attractive alternatives to traditional staged resections.

Cited by 97 publications

References 38 publications

Preliminary Results of ‘Liver-First' Reverse Management for Advanced and Aggressive Synchronous Colorectal Liver Metastases: A Propensity-Matched Analysis

Preliminary Results of ‘Liver-First' Reverse Management for Advanced and Aggressive Synchronous Colorectal Liver Metastases: A Propensity-Matched Analysis

Methods for Vascular Control in Liver Resections Due to Colorectal Metastases - Impact on Residual Parenchyma

Neo-adjuvant chemotherapy followed by surgery versus surgery alone in high-risk patients with resectable colorectal liver metastases: The CHARISMA randomized multicenter clinical trial.

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