Outcomes after Resection of Synchronous or Metachronous Hepatic and Pulmonary Colorectal Metastases

Miller, George V.; Biernacki, Peter; Kemeny, Nancy E.; Gönen, Mithat; Downey, Robert J.; Jarnagin, William R.; D’Angelica, Michael I.; Fong, Yuman; Blumgart, Leslie H.; DeMatteo, Ronald P.

doi:10.1016/j.jamcollsurg.2007.04.039

Cited by 180 publications

(98 citation statements)

References 22 publications

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“…It was possible to extract some data from the included studies to compare these outcomes, but no statistically significant difference could be demonstrated between the two groups. In general, metastasectomies for synchronous metastases are associated with shorter median survival than resection of metachronous metastases; this has been shown in the case of hepatectomy for colorectal metastases [28,29], pulmonary resection for RCC metastases [30] and adrenalectomy for metastatic non-small-cell lung cancer [31]. The previously-mentioned review of case reports and series of pancreatectomy for metastatic RCC suggest that the same principle applies [27]; our data are not consistent with this, but a dedicated study looking specifically at this question remains to be performed.…”

Section: Discussionmentioning

confidence: 96%

Pancreatectomy for metastatic disease: A systematic review

Adler

Redmond

Heneghan

et al. 2014

European Journal of Surgical Oncology (EJSO)

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Aim: Tumours rarely metastasise to the pancreas. While surgical resection of such metastases is believed to confer a survival benefit, there is limited data to support such management. We present a systematic review of case series of pancreatic metastasectomy and analysis of survival outcomes.Methods: A literature search was performed using the PubMed and Cochrane databases and the reference lists of relevant articles, searching for sizeable case series of pancreatic metastasectomy with curative intent. Data extracted included basic demographics, histological primary tumour, presentation, operative management, complications and survival, while the MINORS index was used to assess study quality.Results: 18 studies were found which met our inclusion criteria, involving 399 patients. Renal cell carcinoma (RCC) was the commonest malignancy metastasising to the pancreas, responsible for 62.6% of cases, followed by sarcoma (7.2%) and colorectal carcinoma (6.2%). While survival data was not uniformly reported, the median survival post-metastasectomy was 50.2 months, with a oneyear survival of 86.81% and five-year survival of 50.02%. Median survival for RCC was 71.7 months with 70.4% five-year survival. Median survival was similar in patients with synchronous and metachronous pancreatic metastases, but patients with additional extrapancreatic metastases had a significantly shorter survival than patients with isolated pancreatic metastases (26 versus 45 months). Study quality was poor, with a median MINORS score of 10/16. Conclusions:Within the limitations of a review of non-randomised case series, it would appear that pancreatic metastasectomy confers a survival benefit in selected patients. Better evidence is required, but may prove difficult to acquire. Key words:pancreatic metastasis, metastasectomy, pancreatectomy, metastatic renal cell cancer, 3 Introduction:

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Section: Discussionmentioning

confidence: 96%

Pancreatectomy for metastatic disease: A systematic review

Adler

Redmond

Heneghan

et al. 2014

European Journal of Surgical Oncology (EJSO)

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“…Outcomes in such patients are defined by the extent of hepatic tumor burden (3,11). Although aggressive primary tumor characteristics portend a high risk for distant metastases (10,11), the correlation between primary tumor biology and the extent of intrahepatic metastatic disease requires further clarification.…”

Section: Original Articlementioning

confidence: 99%

“…The most important prognostic factor is the TNM stage and up to 60% of patients with CRC will develop metastases during the course of their disease (2). Outcomes in these patients depend heavily on the nature and extent of distant metastases (3). The significance of primary tumor characteristics, such as lymph node (LN) status on survival in patients with Stage II/III CRC is well established (4,5).…”

Section: Introductionmentioning

confidence: 99%

Association of primary tumor lymph node ratio with burden of liver metastases and survival in stage IV colorectal cancer

Ahmad¹,

Reha²,

Saied³

et al. 2017

Hepatobiliary Surg. Nutr.

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“…2,16 For example, it has been shown that low-volume resectable lung metastases do not preclude long-term survival after hepatic resection. [16][17][18] As the number of liver tumors increases beyond four, the cure rate decreases but does not reach zero. 2 Even in these patients with the worst risk factors, it has been suggested that selective use of hepatic resection is associated with improved long-term outcomes.…”

Section: -14mentioning

confidence: 99%

Metastatic Colorectal Cancer to the Liver: Involve the Surgeon Early and Often

D’Angelica

Kemeny

2015

Ann Surg Oncol

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Hepatic resection for limited metastatic colorectal cancer to the liver (CRLM) is a surgical success story. An associated long-term survival after resection of CRLM has been known for decades. Furthermore, it has now been demonstrated that complete resection of limited CRLM is associated with cure, meaning alive and free of disease 10 years after resection. In most modern series, 5-year survival rates after complete resection are more than 50 % with actual cure rates estimated to be as high as 20-25 %. [1][2][3][4] For example, at Memorial Sloan Kettering Cancer Center patients with limited CRLM treated on trial with adjuvant hepatic artery infusional (HAI) floxuridine (5-FUDR) and systemic 5-fluorouracil (5-FU) had 5-and 10-year survival rates of 59 and 40 %, respectively.5 More recently, in our patients treated on trial with adjuvant HAI and modern systemic chemotherapy, the 5-year survival rate has increased to greater than 70 %.6-8 While selection bias has an impact on some of the overall survival statistics, the potential for cure truly drives the incentive to operate. An important point also is that hepatic resection is now a safe procedure. Many may recall the days of massive blood loss and high mortality rates, but currently hepatic resection for metastases is performed with low blood loss and mortality rates of approximately 1 %. 1,9 Chemotherapy for metastatic colorectal cancer has significantly improved during the past two decades. Response rates in excess of 50 % are commonly reported and 5-year survival rates approaching 10 % are seen in selected patients on trials.10 Unfortunately, systemic chemotherapy alone does not cure patients with CRLM and mandates chronic therapy. Interestingly, this improvement in outcomes seen in patients with unresectable disease has not translated into an improved survival when systemic therapy is given as an adjuvant following hepatic resection. This has now been shown in four randomized trials. 11-14Therefore, hepatic resection for limited liver-only metastatic colorectal cancer is the only potentially curative treatment option. In this nicely written manuscript by Krell et al., it is well demonstrated that medical oncologists (at least in Michigan) are not consistent in their referral practices for patients with CRLM. The majority of the surveyed oncologists work in a community setting that is likely representative of most of the country. Another interesting point is that approximately one-third of the oncologists stated that they did not have a liver surgeon whom to refer patients. As in most good studies, the authors demonstrate some simple but important points. The heterogeneity in referral practices is staggering. Referral rates to liver surgeons range from nearly never to nearly always. Single prognostic factors are commonly used by these oncologists to help decide whether to refer a patient. Many (approximately 40 % of respondents) consider metastasis size and presence of bilateral disease each to be contraindications to hepatic resection. This is troubling, bec...

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Outcomes after Resection of Synchronous or Metachronous Hepatic and Pulmonary Colorectal Metastases

Cited by 180 publications

References 22 publications

Pancreatectomy for metastatic disease: A systematic review

Pancreatectomy for metastatic disease: A systematic review

Association of primary tumor lymph node ratio with burden of liver metastases and survival in stage IV colorectal cancer

Metastatic Colorectal Cancer to the Liver: Involve the Surgeon Early and Often

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