Should Hepatic Metastatic Colorectal Cancer Patients with Extrahepatic Disease Undergo Liver Resection/Ablation?

Byam, Jerome; Reuter, Nathaniel P.; Woodall, Charles E.; Scoggins, Charles R.; McMasters, Kelly M.; Martin, Robert C.G.

doi:10.1245/s10434-009-0693-0

Cited by 25 publications

(23 citation statements)

References 14 publications

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“…Without treatment, median overall survival for patients with CRLM is 8 months [1]; this prognosis worsens where there is both liver and extrahepatic disease (EHD). Current chemotherapeutic regimens can prolong survival in patients with CRLM and EHD to 26.5 months, but best evidence dictates superior outcomes if surgical resection is performed [2-5]. Extension of hepatic metastatic disease to involve adjacent viscera was traditionally a contraindication to resectability.…”

Section: Introductionmentioning

confidence: 99%

Multivisceral Resection for Locally Invasive Colorectal Liver Metastases: Outcomes of a Matched Cohort Analysis

et al. 2018

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Local invasion of adjacent viscera by colorectal liver metastases (CRLM) is no longer considered an absolute contraindication to curative hepatic resection. A growing number of observational analyses have illustrated the feasibility of such resections; however, the evidence base is at best heterogeneous with a lack of evidence comparing similar patient groups. We aimed to evaluate the outcomes of hepatectomy for CRLM when combined with other viscera and compare to a matched cohort of isolated hepatic resections. Methods: From 2005 to 2015, 523 patients underwent hepatic resection for CRLM at our institution, 19 of whom underwent hepatectomy with extrahepatic resection. A 3: 1 matched cohort analysis was performed between those who underwent isolated hepatectomy (control group) and those who underwent hepatectomy with extrahepatic resection (combined group). Clinicopathological data were reviewed along with 30-day postoperative morbidity and mortality. Furthermore, overall survival for the multivisceral cohort was compared to all other isolated hepatectomies over the same time period. Results: Nineteen patients underwent liver resection accompanied by either/or diaphragmatic resection (n = 13), major vein resection and reconstruction (n = 5), and visceral resection (n = 3). Maximum tumor size was significantly larger in the combined group (60.58 vs. 15.34 mm p < 0.0001). Postoperative morbidity was similar in both groups (p = 0.41). Following multivisceral resection, 1-, 3- and 5-year survival rates were 75, 56.6, and 25.7% respectively. Overall survival showed no significant difference between combined and control groups (p = 0.78). Similarly, when compared to the total cohort of isolated liver resections (n = 504), no significant difference in overall mortality was noted. Conclusion: In patients presenting with concomitant CRLM and extrahepatic extension where R0 margins can be achieved, this present study supports the rationale to proceed to surgery with comparable morbidity and mortality rates to isolated hepatectomy.

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Section: Introductionmentioning

confidence: 99%

Multivisceral Resection for Locally Invasive Colorectal Liver Metastases: Outcomes of a Matched Cohort Analysis

et al. 2018

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“…In the last decade, some authors reported favorable survival results in selected patients with CHEHMs, in which complete resection of all metastatic disease (8)(9)(10)(11) could be performed. Currently, several centers consider that the presence of CEMs is no longer an absolute contraindication to liver resection (if complete resection of hepatic and extrahepatic disease can be performed), extrahepatic disease representing only a poor prognostic factor for patients with CHMs.…”

Section: Introductionmentioning

confidence: 99%

Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Diaconescu¹,

Alexandrescu²,

Ionel³

et al. 2017

chr

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Introducere: Beneficiul rezecţiei hepatice în cazul metastazelor hepatice şi extrahepatice colorectale (MHEHCR) este încă discutabil. Scopul acestui studiu este de a evalua rezultatele rezecţiei metastazelor hepatice şi extrahepatice efectuate pacienţilor cu MHEHCR într-un centru medical cu un volum mare de intervenţii chirurgicale, atât în sfera chirurgiei hepato-biliare, cât şi în sfera chirurgiei colo-rectale şi de a identifica factorii de prognostic care se corelează cu o supravieţuire îndelungată. Metoda: Studiul este unul retrospectiv şi se bazează pe un lot de 678 de pacienţi consecutivi, cu metastaze hepatice ale cancerului colo-rectal operate într-un singur centru chirurgical, în perioada aprilie 1996 -martie 2016. Dintre aceştia, 73 de pacienţi au prezentat MHEHCR. Analiza univariată a fost efectuată pentru identificarea acelor factori de risc ce influenţează supravieţuirea generală (SG) . Rezultate: Au fost 20 de metastaze extrahepatice localizate la nivelul pediculului hepatic, 20 la nivel peritoneal, 12 la nivel ovarian şi pulmonar, 9 cu alte localizări şi 12 recidive locale. Au fost efectuate 53 de rezecţii curative (RO). Supravieţuirea Original ArticleChirurgia (2017) comparativă între lotul pacienţilor cu MHEHCR şi cel al pacienţilor cu metastaze strict hepatice a arătat o diferenţă semnificativă statistic în favoarea celui de-al doilea lot (p <0,0001), acelaşi rezultat fiind înregistrat şi în prezenţa rezecţiei R0 în cele două loturi (p <0,0001). În grupul MHEHCR, SG a fost semnificativă statistic mai mare la pacienţii care au beneficiat de rezecţie R0 faţă de cei la care rezecţia a fost R1/R2 (p = 0,004). Analiza univariată a identificat trei variabile drept factori de prognostic negativ pentru SG: 4 sau mai multe metastaze hepatice, efectuarea unei hepatectomii majore şi perioada realizării rezecţiei hepatice (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). Localizarea ovariană sau pulmonară a metastazelor extrahepatice este corelată cu cea mai bună rată de supravieţuire dintre toate localizările posibile dar fară a fi semnificativă statistic. Concluzie: La pacienţii cu metastaze hepatice şi extrahepatice concomitente, rezecţia completă (R0) a acestora prelungeşte în mod semnificativ supravieţuirea. Pacienţii cu mai puţin de 4 metastaze hepatice, a căror rezecţie este realizată printr-o hepatectomie minoră sunt cei care beneficiază cel mai mult de pe urma acestei conduite terapeutice onco-chirurgicale agresive.Cuvinte cheie: metastaze hepatice ale cancerului colo-rectal, metastaze extrahepatice, metastaze hepatice şi extrahepatice ale cancerului colo-rectal, rezecţie hepatică, supravieţuire generală, factori de prognostic AbstractBackground: The benefit of hepatic resection in case of concomitant colorectal hepatic and extrahepatic metastases (CHEHMs) is still debatable. The purpose of this study is to assess the results of resection of hepatic and extrahepatic metastases in patients with CHEHMs in a high-volume center for both hepatobiliary and colorectal surgery and to identify progn...

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“…Although the role of surgery in presence of multiple sites of MCC is almost un-explored, the combined and/ or sequential resection of liver, lymph nodes, lung metastases in various combinations has been tested with encouraging outcomes in very selected cases [11] . Radical surgery for concomitant liver and extra-hepatic MCC has shown results that seem comparable to those obtained for isolated hepatic metastases [12][13][14][15] . For colorectal liver metastases (LM), radical surgery offers a chance of cure in at least 17% of patients and liver resection (LR) has become the standard treatment for patients with resectable disease [16] .…”

Section: Introductionmentioning

confidence: 67%

Treatment of liver metastases in patients selected for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis

Sommariva¹

2017

JCMT

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How to cite this article: Sommariva A. Treatment of liver metastases in patients selected for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis. J Cancer Metastasis Treat 2017;3:362-7. Cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have gained increasing consensus in treatment of peritoneal carcinomatosis from colorectal cancer. The presence of liver metastases is generally considered a contraindication for CS + HIPEC, as hepatic involvement no longer represents a loco-regional aspect of disease. Despite this, liver resection (LR) has been tested in selected cases in combination with CS + HIPEC for treatment of peritoneal carcinomatosis with liver metastasis. Relevant studies on this topic were identified through a search in the electronic PubMed database, using the appropriate keywords. CS + HIPEC + LR allows similar outcomes in terms of survival and morbidity with respect to CS + HIPEC, especially in patients with low tumor load. CS + HIPEC + LR represents a reasonable approach for patients with peritoneal carcinomatosis and liver metastases from colorectal cancer. Patients should be selected in high volume tertiary centres, preferably in the context of a prospective trial. Quick Key words:Colorectal cancer, peritoneal carcinomatosis, liver metastases, hyperthermic intraperitoneal chemotherapy, liver resection ABSTRACTArticle history:

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Should Hepatic Metastatic Colorectal Cancer Patients with Extrahepatic Disease Undergo Liver Resection/Ablation?

Abstract: A thorough understanding of the biology of disease and appropriate multimodality care can lead to improved survival in patients with EHD, when compared with chemotherapy alone.

Cited by 25 publications

References 14 publications

Multivisceral Resection for Locally Invasive Colorectal Liver Metastases: Outcomes of a Matched Cohort Analysis

Multivisceral Resection for Locally Invasive Colorectal Liver Metastases: Outcomes of a Matched Cohort Analysis

Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Treatment of liver metastases in patients selected for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis

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