Simultaneous resection for colorectal cancer with synchronous liver metastases is a safe procedure: Outcomes at a single center in Turkey

Dulundu, Ender; Attaallah, Wafi; Tilki, Metin; Yeğen, Cumhur; Coskun, Safak; Coşkun, Mümin; Erdim, Aylin; Tanrıkulu, Eda; Yardimci, Samet; Günal, Ömer

doi:10.5582/bst.2017.01019

Cited by 8 publications

(5 citation statements)

References 49 publications

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“…For example, Gasser et al[ 12 ] found patients with a l -CRCLM had 22 mo longer median overall survival compared to r -CRCLM ( P = 0.051). This contrasts with only 2 studies that showed lower OS in patients with l -CRCLM study, Dulundu et al[ 19 ] and Viganò et al[ 20 ], but neither with statistical significance ( P = 0.072 and P < 0.05 respectively). These results are summarised in Table 2 .…”

Section: Resultscontrasting

confidence: 61%

Impact of primary tumour location on colorectal liver metastases: A systematic review

Bingham¹,

Shetye²,

Suresh³

et al. 2020

WJCO

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BACKGROUND Colorectal cancer (CRC) is the third most common cause of cancer-related death worldwide. Despite significant advances in screening, surgical management and adjuvant therapies, average 5-year survival seldom exceeds 60% in most developed nations. Metastatic disease represents the primary cause of mortality in patients with CRC, and the liver is the most common location for distant tumour spread. Up to 25% of patients are found to have synchronous liver metastases at the time of diagnosis and a further 30%-40% will develop metachronous disease in the course of follow-up. It has been suggested that primary tumour location [right side versus left side, primary tumour location (PTL)] can influence oncological outcomes in this patient group and that this should be considered in prognostic models and therapeutic decision-making algorithms. This suggestion is not universally accepted and there have been conflicting reports in the literature to date. AIM To provide a comprehensive summary of the available evidence regarding the impact of PTL on oncological outcomes in patients with colorectal cancer liver metastases (CRCLM). METHODS MEDLINE, EMBASE and COCHRANE were searched for relevant publications using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Data on oncological outcomes was then extracted from full text articles that met the predefined inclusion criteria. RESULTS A total of 41 studies were identified that met predefined inclusion criteria for this review. In 21 out of 38 studies that provided data on overall survival, a statistically significant improvement in overall survival was reported in patients with left sided primary tumours. These studies included a total of 13897 patients compared with 4306 patients in the studies that did not show a significant difference. Eight studies noted a similar trend towards improved disease-free or progression-free survival. Several authors observed distinct patterns of relapse after treatment of hepatic metastases according to PTL; for example hepatic recurrence after treatment of CRCLM appears to occur more aggressively with right-sided CRC. CONCLUSION Taken together, the findings of the present review indicate that PTL may have a role as an independent prognostic factor when determining treatment and disease surveillance strategies in CRC. The mechanisms responsible for this variation remain poorly understood, but are likely to relate to molecular, histological and embryological differences, as well as inherent differences in therapeutic sensitivity.

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Section: Resultscontrasting

confidence: 61%

Impact of primary tumour location on colorectal liver metastases: A systematic review

Bingham¹,

Shetye²,

Suresh³

et al. 2020

WJCO

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“…Although the results of the authors are valuable, our patient number is higher, and we found no correlation regarding the number of metastasis in our study. Other studies from Turkey include three retrospective [15][16][17] analysis a case [18]. One of the retrospective analysis by Dulundu et al [15] have evaluated simultaneous resection of liver and colorectal cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies from Turkey include three retrospective [15][16][17] analysis a case [18]. One of the retrospective analysis by Dulundu et al [15] have evaluated simultaneous resection of liver and colorectal cancer. Another study by Cokmert et al [16] have evaluated 99 patients with CRLM and 52 underwent synchronous colorectal and liver resection, while 5 patients underwent liver resection following chemotherapy and another 42 patients underwent metachronous liver resection.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results and Prognostic Significance of Non-ANATOMIC Liver Resection for Colorectal Liver Metastasis: Single Center Experience

Civil

Okkabaz²,

Şahin

et al. 2019

Indian J Surg

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Development of liver metastasis is a single poor prognostic indicator if left untreated, and therefore management of colorectal liver metastasis (CRLM) is a subject of active multidisciplinary approach. We aimed to evaluate the long-term results and poor prognostic indicators in patients undergoing liver resection for CRLM from a single center in Turkey. All patients who underwent hepatic resection due to colorectal metastasis between March 2007 and November 2011 in our institute were included. Demographic data, operative and postoperative parameters, and long-term follow-up data were analyzed. A total of 44 patients [29 (65.9%) male, median age: 61 (32-81) years] were included to the study. Most of the patients [28 (63.6%) had metachronous liver metastasis, and almost half of the patients [19 (45.2%)] was oligometastatic. Major resection was performed in 18 (40.9%) patients. Intraoperative US changed the operative strategy in 7 (19.4%) patients. Thirty-day mortality was observed in 4 (9.1%) patients. Reasons for mortality were uncontrolled sepsis [catheter infection (n = 1), anastomotic leak (n = 1), and intraabdominal abscess (n = 1)] and hepatic insufficiency (n = 1). Follow-up period excluding patients with early mortality was 30.4 (3-138) months. Kaplan-Meier survival analysis revealed that estimated median survival time after hepatic resection was 28 (95% CI: 20.6-35.4) months. Five-year and 10-year survival probabilities were 20.5% and 13.3%, respectively. Multivariate Cox regression analyses showed that surgical margin positivity was the only significant factor affecting survival. Our results suggest that tumor margin and number of metastasis are the two determinant prognostic indicators in patients with CRLM. Surgery seems to offer a chance for cure, and surgeons in the field should try to perform liver resections in order to obtain negative margins. Major hepatic resections are justified provided that patient selection and preparation is thorough and surgical procedure can be performed safely.

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“…Compared with systemic therapies, complete resection of both the primary tumour and liver metastases was associated with favourable oncological outcomes in colorectal cancer liver metastases (CRLM) patients ( 4 , 5 ). For resectable CRLM, a traditional staged procedure in which CRC resection was performed before or after liver metastasis resection increased the risk of liver metastasis progression and dissemination to other distant sites in the interval between the two operations ( 6 ), while simultaneous resections of both lesions could reduce the abovementioned risks, provide the benefit of short hospital stays, reduce hospital costs and improve patient experiences ( 6 , 7 ). As previous studies suggested, simultaneous resections of primary lesions and liver metastases exhibit comparable short-term outcomes and have a tendency to improve long-term outcomes such as progression-free survival and overall survival (OS) in comparison with traditional staged procedures ( 6 - 8 ).…”

Section: Introductionmentioning

confidence: 99%

Nomogram predicting early recurrence defined by the minimum P value approach for colorectal liver metastasis patients receiving colorectal cancer resection with simultaneous liver metastasis resection: development and validation

Deng¹,

Chen²,

Liu³

et al. 2023

J Gastrointest Oncol

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Background Simultaneous resections have been increasingly performed for colorectal liver metastasis patients. However, studies explored risk stratification for these patients are scarce. Among which, a clear definition of early recurrence remains controversial and models for predicting early recurrence in these patients are lacking. Methods Colorectal liver metastasis patients who developed recurrence followed by simultaneous resection were enrolled. Early recurrence was determined by the minimum P value method, and patients were divided into an early recurrence group and late recurrence group. Standard clinical data were collected from each patient including demographics features, preoperative laboratory tests and postoperative regular follow-up results. All the data were accessed by clinicians and recorded accordingly. The nomogram for early recurrence was constructed in the training cohort and validated externally in the test cohort. Results The optimal value of early recurrence by the minimum P value method was 13 months. A total of 323 patients were included in the training cohort, of which 241 (74.6%) experienced early recurrence. Seventy-one patients were included in the test cohort, of which 49 (69.0%) experienced early recurrence. Significantly worse post-recurrence survival (median 27.0 vs. 52.8 months, P=0.00083) and overall survival (median 33.8 vs. 70.9 months, P<0.0001) were observed in patients with early recurrence in the training cohort. Positive lymph node metastases (P=0.003), tumour burden scores ≥4.09 (P=0.001), preoperative neutrophil-to-lymphocyte ratios ≥1.44 (P=0.006), preoperative blood urea nitrogen levels ≥3.55 µmol/L (P=0.017) and postoperative complications (P=0.042) were independently associated with early recurrence, and all these predictors were included in the nomogram. The nomogram for predicting early recurrence had a receiver operating characteristic curve of 0.720 in the training cohort and a receiver operating characteristic curve of 0.740 in the test cohort. The Hosmer-Lemeshow test and calibration curves showed acceptable model calibration in the training set (P=0.7612) and in the test set (P=0.8671). The decision curve analysis results for the training cohort and test cohort also indicated that the nomogram showed good clinical applicability. Conclusions Our findings provide clinicians with new insights into accurate risk stratification for colorectal liver metastasis patients receiving simultaneous resection and contributing to the management of patients.

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Simultaneous resection for colorectal cancer with synchronous liver metastases is a safe procedure: Outcomes at a single center in Turkey

Cited by 8 publications

References 49 publications

Impact of primary tumour location on colorectal liver metastases: A systematic review

Impact of primary tumour location on colorectal liver metastases: A systematic review

Long-Term Results and Prognostic Significance of Non-ANATOMIC Liver Resection for Colorectal Liver Metastasis: Single Center Experience

Nomogram predicting early recurrence defined by the minimum P value approach for colorectal liver metastasis patients receiving colorectal cancer resection with simultaneous liver metastasis resection: development and validation

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