Selection Criteria for Simultaneous Resection in Patients With Synchronous Liver Metastasis

Minagawa, Masami; Yamamoto, Junji; Miwa, Shiro; Sakamoto, Yoshihiro; Kokudo, Norihiro; Kosuge, Tomoo; Miyagawa, Shinichi; Makuuchi, Masatoshi

doi:10.1001/archsurg.141.10.1006

Cited by 104 publications

(86 citation statements)

References 40 publications

(61 reference statements)

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“…The factor that most influenced the OS was related to the surgery, with R1/R2 resections increasing 6-fold the risk of death. Similar results were reported in most studies (10,(37)(38)(39), although recent papers suggested that the results of R1 resection are mitigated in present by the effective oncologic therapies (40)(41)(42)(43)(44)(45). However, prospective R2 resections are still an absolute contraindication to liver resection for CLMs and whenever possible, a negative resection margin larger than 1 mm should be achieved (36,(46)(47)(48).…”

Section: Discussion Discussionsupporting

confidence: 78%

Prognostic Factors for Survival after Resection of Liver Metastases from Colorectal Cancer: A Single Institution Analysis of 655 Cases

Alexandrescu¹,

Diaconescu²,

Zarnescu³

et al. 2017

SGO

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Backgound: Several clinical risk factors for patients undergoing liver resection for colorectal liver metastases were suggested. The purpose of the study was to evaluate the prognostic factors for survival after resection of liver metastases from colorectal cancer in a high volume center for both hepatobiliary and colorectal surgery. Methods: We completed a retrospective analysis on 655 consecutive patients with liver resection for colorectal cancer metastasis operated in our centre between April 1996 and March 2016. Preoperative, intraoperative, pathologic, and outcome data for patients undergoing liver resection for metastatic colorectal were examined. Univariate analysis followed by multivariate Cox regression analysis was performed in order to identify the risk factors associated with prognostic factors related to survival. Results: There were 371 men (56.65%) and 284 women (43.35%), with a median age of 60 year-old (range 24 to 84). The primary tumor location was colon in 454 cases (69.31%) and rectum for 201 cases (30.69%). Synchronous tumors were resected in 353 cases (53.72%). The surgical mortality rate was 2.95%. The 5-year survival rate was 29.2%, and the 10-year survival rate was 17.1%. Four factors were found to be significant independent predictors of poor long-term outcome by multivariate analysis: bilobar liver metastasis (p = 0.003) with HR 1.653 (95%CI 1.180 -2.316), non-R0 resection (p < 0.001) with HR 6.066 (95%CI 3.508 -10.489), N2 lymph node stage (p = 0.007) with HR 1.528 (95%CI 1.125 -2.075) and lack of adjuvant chemotherapy (p = 0.046) with HR 1.703 (95%CI 1.009 -2.873). Conclusion:The independent prognostic factors for poor OS were both clinico-pathologic and therapeutic. In patients with good prognostic factors, an appropriate onco-surgical treatment is able to significantly prolong survival. In patients with poor prognostic factors, prognosis is mainly influenced by tumor biology and the benefit from current therapies is still modest.

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Section: Discussion Discussionsupporting

confidence: 78%

Prognostic Factors for Survival after Resection of Liver Metastases from Colorectal Cancer: A Single Institution Analysis of 655 Cases

Alexandrescu¹,

Diaconescu²,

Zarnescu³

et al. 2017

SGO

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“…Performance status has been shown to be associated with clinical outcomes, and while we controlled for comorbidities and age, poor performance status may have been associated with both access to care and poor outcome. We also do not have information on the individual serum carcinoembryonic antigen levels or the specific nature of the metastases in each patient, for example, the number of metastases, sizes of metastases, and other sites of metastases (Minagawa et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

Predictors of survival after hepatic resection among patients with colorectal liver metastasis

et al. 2007

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Studies suggest improved survival following resection of colorectal cancer liver metastases (CLMs). We investigated predictors of survival among patients with CLM who underwent hepatic resection using the SEER-Medicare database to identify patients X65 years diagnosed with CLM, 1991CLM, -2003, who underwent hepatectomy. Cox proportional hazards models were used to identify factors associated with survival after hepatectomy. Of 923 patients with CLM who underwent hepatectomy, 514 were stages I -III and developed CLM46 months after diagnosis (metachronous), and 409 were stage IV with CLM at diagnosis (synchronous). From the date of hepatectomy, 5 year survival was 22%; younger age, being married, female gender, surgery in an NCI-designated cancer centre, fewer comorbidities, fewer positive lymph nodes, and lower grade were associated with improved survival. Both 5-fluorouracil (5FU)-based chemotherapy and hepatic arterial infusion (HAI) of floxuridine-based chemotherapy following hepatectomy improved survival (HR ¼ 0.62, 95% CI: 0.50 -0.78; HR ¼ 0.51, 95% CI: 0.28 -0.97, respectively) in the synchronous, but not metachronous, group. The HR for overall mortality was higher in hospitals with a high vs low procedure volume (0.75, 95% CI: 0.58 -0.94). A substantial subgroup of patients with CLM who undergo hepatectomy experiences long-term survival. High hospital procedure volume and use of 5FU-based or HAI-based chemotherapy after resection were associated with improved prognosis.

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“…At presentation, 23-51% of patients diagnosed with colorectal cancer have synchronous liver metastases (10). Patients with synchronous disease require co-ordination of multiple providers in order to optimize the timing and sequence of therapies, with the management of rectal cancer and synchronous metastatic disease posing an especially difficult dilemma.…”

Section: Introductionmentioning

confidence: 99%

Management of colorectal cancer with synchronous liver metastases: impact of multidisciplinary case conference review

Wanis¹,

Pineda-Solís²,

Tun-Abraham³

et al. 2017

Hepatobiliary Surg. Nutr.

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Background: While no evidence exists to support mandatory multidisciplinary case conference (MCC) review for patients with synchronous colorectal cancer and liver metastases, this unique population may benefit greatly from multidisciplinary discussion. Methods:We retrospectively identified patients who underwent liver resection with curative intent for colorectal liver metastases (CRLM) at a tertiary center between January 2008 and June 2015. The characteristics of patients discussed at a weekly regional MCC were examined, and the effect of MCC review on treatment approach was assessed.Results: Sixty-six patients underwent elective surgery for synchronous colorectal cancer and liver metastases during the study period. Twenty-nine patients (44%) were presented at a MCC. Presentation was associated with greater likelihood of undergoing simultaneous or liver-first resection (P≤0.0001), with no difference in the extent of liver resection or location of primary tumor between the groups. A greater proportion of patients received chemotherapy and/or radiation following MCC discussion, without statistical significance. Conclusions:The treatment approach for patients with synchronous colorectal cancer and liver metastases may be significantly altered based on MCC review. Multidisciplinary discussion is advocated in order to facilitate equal access to individualized care.

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Selection Criteria for Simultaneous Resection in Patients With Synchronous Liver Metastasis

Cited by 104 publications

References 40 publications

Prognostic Factors for Survival after Resection of Liver Metastases from Colorectal Cancer: A Single Institution Analysis of 655 Cases

Prognostic Factors for Survival after Resection of Liver Metastases from Colorectal Cancer: A Single Institution Analysis of 655 Cases

Predictors of survival after hepatic resection among patients with colorectal liver metastasis

Management of colorectal cancer with synchronous liver metastases: impact of multidisciplinary case conference review

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