Repeat hepatectomy for recurrent colorectal metastases

Wicherts, Dennis A.; Haas, Robbert J. de; Salloum, Chady; Andreani, P.; Pascal, G.; Sotirov, D; Adam, René; Castaing, Denis; Azoulay, Daniel

doi:10.1002/bjs.9088

Cited by 137 publications

(125 citation statements)

References 53 publications

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“…These data agree with the conclusions of a recent meta-analysis of studies assessing repeat hepatectomy for recurrent CRLM [25]. While this earlier analysis found no significant difference in overall survival between the single resection and repeat resection groups when all studies were evaluated, repetition of analyses to include just high-quality studies [11,12,14,15] or just studies with greater than 500 cases demonstrated that repeat resection was significantly associated with improved overall survival following metastasectomy. In agreement with this, Saiura et al recently found the performance of repeat resection to be independently associated with prolonged overall survival following metastasectomy [26].…”

Section: Discussionsupporting

confidence: 87%

“…Studies to date, however, have yielded conflicting results regarding the influence of repeat hepatectomy for CRLM upon longterm survival [11][12][13][14][15][16][17]. A notable finding of this study was that repeat hepatectomy was significantly associated with improved overall and cancer-specific survival following metastasectomy, along with established prognostic factors including tumor number and margin status.…”

Section: Discussionmentioning

confidence: 85%

“…There were 308 (63.1%) men and 180 (36.9%) women. At index hepatectomy, the median number of tumors on preoperative imaging was two (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Tumor size ranged from 5 to 150 mm, with a median size of 35 mm.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…While several large cohort studies have demonstrated repeat hepatectomy for recurrent CRLM to be associated with a survival benefit compared to patients undergoing a single hepatectomy [11,12], other studies have yielded comparable long-term results between the two groups [13][14][15][16][17]. In addition, although improved survival after repeat hepatectomy has been shown in some studies, varying patient outcomes have been reported within individual studies.…”

Section: Introductionmentioning

confidence: 99%

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Repeat hepatectomy is independently associated with favorable long‐term outcome in patients with colorectal liver metastases

et al. 2017

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Up to three-quarters of patients undergoing liver resection for colorectal liver metastases (CRLM) develop intrahepatic recurrence. Repeat hepatic resection appears to provide the optimal chance of cure for these patients. The aim of this study was to analyze short-and long-term outcomes following index and repeat hepatectomy for CRLM. Clinicopathological data were obtained from a prospectively maintained database. Perioperative variables and outcomes were compared using the Chi-squared test. Variables associated with long-term survival following index and second hepatectomy were identified by Cox regression analyses. Over the study period, 488 patients underwent hepatic resection for CRLM, with 71 patients undergoing repeat hepatectomy. There was no significant difference in rates of morbidity (P = 0.135), major morbidity (P = 0.638), or mortality (P = 0.623) when index and second hepatectomy were compared. Performance of repeat hepatectomy was independently associated with increased overall and cancer-specific survival following index hepatectomy. Short diseasefree interval between index and second hepatectomy, number of liver metastases >1, and resection of extrahepatic disease were independently associated with shortened survival following repeat resection. Repeat hepatectomy for recurrent CRLM offers short-term outcomes equivalent to those of patients undergoing index hepatectomy, while being independently associated with improved longterm patient survival. Cancer MedicineOpen Access 332

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 85%

Section: Patient Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Repeat hepatectomy is independently associated with favorable long‐term outcome in patients with colorectal liver metastases

et al. 2017

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“…The frequencies of repeat hepatectomies for recurring CRC in patients with initially unresectable metastases, observed between January 1990 and January 2010 in a French hospital, were reported by Wicherts et al 174 ( Table 115). In total, 1.4 operations were carried out per patient.…”

Section: Laparoscopic Surgery (£)mentioning

confidence: 79%

The clinical effectiveness and cost-effectiveness of cetuximab (review of technology appraisal no. 176) and panitumumab (partial review of technology appraisal no. 240) for previously untreated metastatic colorectal cancer: a systematic review and economic evaluation

Huxley

Crathorne

Varley-Campbell

et al. 2017

Health Technol Assess

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BackgroundColorectal cancer is the fourth most commonly diagnosed cancer in the UK after breast, lung and prostate cancer. People with metastatic disease who are sufficiently fit are usually treated with active chemotherapy as first- or second-line therapy. Targeted agents are available, including the antiepidermal growth factor receptor (EGFR) agents cetuximab (Erbitux®, Merck Serono UK Ltd, Feltham, UK) and panitumumab (Vecitibix®, Amgen UK Ltd, Cambridge, UK).ObjectiveTo investigate the clinical effectiveness and cost-effectiveness of panitumumab in combination with chemotherapy and cetuximab in combination with chemotherapy for rat sarcoma (RAS) wild-type (WT) patients for the first-line treatment of metastatic colorectal cancer.Data sourcesThe assessment included a systematic review of clinical effectiveness and cost-effectiveness studies, a review and critique of manufacturer submissions, and a de novo cohort-based economic analysis. For the assessment of effectiveness, a literature search was conducted up to 27 April 2015 in a range of electronic databases, including MEDLINE, EMBASE and The Cochrane Library.Review methodsStudies were included if they were randomised controlled trials (RCTs) or systematic reviews of RCTs of cetuximab or panitumumab in participants with previously untreated metastatic colorectal cancer withRASWT status. All steps in the review were performed by one reviewer and checked independently by a second. Narrative synthesis and network meta-analyses (NMAs) were conducted for outcomes of interest. An economic model was developed focusing on first-line treatment and using a 30-year time horizon to capture costs and benefits. Costs and benefits were discounted at 3.5% per annum. Scenario analyses and probabilistic and univariate deterministic sensitivity analyses were performed.ResultsThe searches identified 2811 titles and abstracts, of which five clinical trials were included. Additional data from these trials were provided by the manufacturers. No data were available for panitumumab plus irinotecan-based chemotherapy (folinic acid + 5-fluorouracil + irinotecan) (FOLFIRI) in previously untreated patients. Studies reported results forRASWT subgroups. First-line treatment with anti-EGFR therapies in combination with chemotherapy appeared to have statistically significant benefits for patients who areRASWT. For the independent economic evaluation, the base-case incremental cost-effectiveness ratio (ICER) forRASWT patients for cetuximab plus oxaliplatin-based chemotherapy (folinic acid + 5-fluorouracil + oxaliplatin) (FOLFOX) compared with FOLFOX was £104,205 per quality-adjusted life-year (QALY) gained; for panitumumab plus FOLFOX compared with FOLFOX was £204,103 per QALY gained; and for cetuximab plus FOLFIRI compared with FOLFIRI was £122,554 per QALY gained. The ICERs were sensitive to treatment duration, progression-free survival, overall survival (resected patients only) and resection rates.LimitationsThe trials includedRASWT populations only as subgroups. No evidence was available for panitumumab plus FOLFIRI. Two networks were used for the NMA and model, based on the different chemotherapies (FOLFOX and FOLFIRI), as insufficient evidence was available to the assessment group to connect these networks.ConclusionsAlthough cetuximab and panitumumab in combination with chemotherapy appear to be clinically beneficial forRASWT patients compared with chemotherapy alone, they are likely to represent poor value for money when judged by cost-effectiveness criteria currently used in the UK. It would be useful to conduct a RCT in patients withRASWT.Study registrationThis study is registered as PROSPERO CRD42015016111.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Outcomes after resection and/or radiofrequency ablation for recurrence after treatment of colorectal liver metastases

Hof

Wertenbroek

Peeters

et al. 2016

British Journal of Surgery

101

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Repeat hepatectomy for recurrent colorectal metastases

Abstract: Repeat hepatectomy for recurrent colorectal metastases offers long-term survival in selected patients.

Cited by 137 publications

References 53 publications

Repeat hepatectomy is independently associated with favorable long‐term outcome in patients with colorectal liver metastases

Repeat hepatectomy is independently associated with favorable long‐term outcome in patients with colorectal liver metastases

The clinical effectiveness and cost-effectiveness of cetuximab (review of technology appraisal no. 176) and panitumumab (partial review of technology appraisal no. 240) for previously untreated metastatic colorectal cancer: a systematic review and economic evaluation

Outcomes after resection and/or radiofrequency ablation for recurrence after treatment of colorectal liver metastases

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