R1 resection for aggressive or advanced colorectal liver metastases is justified in combination with effective prehepatectomy chemotherapy

Tanaka, Kuniya; Nojiri, Kazunori; Kumamoto, Takafumi; Takeda, Kazuhisa; Endo, Itaru

doi:10.1016/j.ejso.2011.01.007

Cited by 32 publications

(45 citation statements)

References 21 publications

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“…Recent reports of a favorable result in R1 resection, a designation denoting histopathologically evident cancer cells at the line of resection, likely reflect various advances-especially increasingly effective chemotherapy regimens. 12,13 According to our present results, if a metastasis was attached to >25% of the extent of a vessel by imaging but tumor size reduction of !60% was accomplished with chemotherapy, the metastasis was likely to be attached to the vessel without invasion at the time of pathological examination. If a predicted positive surgical margin after resection is no longer an absolute contraindication to surgery for treating advanced and aggressive liver metastases, 12,13 tumor size reduction by !60% could permit resection that preserves the vessel showing attachment, without vascular resection or reconstruction.…”

Section: Discussionsupporting

confidence: 54%

Postchemotherapy histological analysis of major intrahepatic vessels for reversal of attachment or invasion by colorectal liver metastases

Tanaka

Kumamoto

Nojiri

et al. 2011

Cancer

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BACKGROUND: Although tumor reduction via present-day prehepatectomy chemotherapy can render initially unresectable disease potentially resectable, little is known about the effects of such chemotherapy on liver metastases with known attachment to or invasion of major intrahepatic vessels. We histologically assessed the relationships of liver tumors to major intrahepatic vessels after chemotherapy. METHODS: In 45 patients who underwent chemotherapy and hepatectomy with pretreatment images showing metastases attached to or invading major intrahepatic vessels, 77 metastases showed attachment to or invasion of 96 vessels. RESULTS: Using postchemotherapy imaging, 11 of 77 metastases (14.3%) appeared separated from 12 of 96 major hepatic vessels (12.5%). Among 83 vessels later examined pathologically, 29 showed direct invasion (35%) and 10 showed attachment (12%). Tumors involved another 9 vessels (11%) that were separated surgically from the tumor and preserved during hepatectomy. Tumor attachment that exceeded 25% of vessel circumferences via imaging after chemotherapy was a factor associated with pathological vascular invasion or attachment according to multivariate analysis (relative risk, 8.449; 95% confidence interval, 1.961-36.415; P ¼ .0042). CONCLUSIONS: Liver metastasis attachment to or invasion of major intrahepatic vessels is difficult to eradicate even with otherwise effective chemotherapy.

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Section: Discussionsupporting

confidence: 54%

Postchemotherapy histological analysis of major intrahepatic vessels for reversal of attachment or invasion by colorectal liver metastases

Tanaka

Kumamoto

Nojiri

et al. 2011

Cancer

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“…Although twelve prognostic scoring systems have been identified from 1996 to 2009, there is no 'ideal' system for the clinical management of patients with colorectal liver metastases (Gomez et al, 2010). A predicted positive surgical margin (R1 resection) is not any absolute contraindication to surgery for aggressive or advanced colorectal liver metastases (Tanaka et al, 2011). Liver resection has superior long-term survival which is, however, significantly reduced by the occurrence of post-surgical complications (Schepers et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Resection for Colorectal Liver Metastases

Kostov¹,

Kobakov²

2012

Colorectal Cancer - From Prevention to Patient Care

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“…Together with the actual literature and the new multi-modal chemotherapy treatment options, a predicted positive surgical resection margin no longer should be an absolute contraindication for aggressive or advanced surgery of liver metastases. Although an R1 resection should clearly be avoided, the tumor biology is the more important predictor for intrahepatic recurrence and survival rather than millimeters of the resection margin [48,49].…”

Section: Discussionmentioning

confidence: 99%