Surgical management and outcomes of colorectal cancer liver metastases

Morris, Eva; Forman, David; Thomas, James; Quirke, Philip; Taylor, E F; Fairley, Lesley; Cottier, B.; Poston, Graeme J.

doi:10.1002/bjs.7032

Cited by 320 publications

(129 citation statements)

References 19 publications

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“…To improve survival, various liver-directed treatment strategies for liver metastasis from gastric cancer, in combination with systemic chemotherapy, have been applied, such as surgical resection, radiofrequency ablation (RFA), and hepatic artery infusion chemotherapy [7][8][9][10][11]. Meanwhile, for liver metastases from colorectal cancer and neuroendocrine tumors, surgical resection is the treatment of choice [12,13]. RFA, a localized application of thermal energy that induces coagulation necrosis and thereby tumor cell destruction, has also been used to treat primary liver malignancies and liver metastasis from other organ malignancies, including colorectal, breast, and neuroendocrine cancer [14][15][16].…”

Section: And Woo Jin Hyungmentioning

confidence: 99%

Liver-directed treatments for liver metastasis from gastric adenocarcinoma: comparison between liver resection and radiofrequency ablation

et al. 2015

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Background Although various liver-directed treatment modalities, such as liver resection and radiofrequency ablation (RFA), have been applied to treat liver metastases from gastric cancer, optimal management of them remains controversial. In patients with liver metastasis from gastric cancer, we investigated the short-and long-term outcomes of liver resection and RFA and analyzed factors influencing survival. Methods A total of 98 gastric cancer patients with liver metastasis and no extrahepatic disease were treated by liver resection (n = 68) or RFA (n = 30). Short-and long-term outcomes were evaluated retrospectively for each of the liver-directed treatments. Results Severe complication rates did not differ between liver resection (18 %) and RFA (10 %) (p = 0.333). Only one treatment-related mortality occurred in the liver resection group. No statistically significant difference in survival was noted between the treatment groups. Median overall survival after liver resection was 24 months, with 3-year overall and progression-free survival rates of 40.6 % and 30.4 %, respectively. Median overall survival after RFA was 23 months, with 3-year overall and progression-free survival rates of 43.0 % and 37.4 %, respectively. Only the size of the metastases was shown to be an independent prognostic factor for gastric cancer patients with liver metastasis. Conclusions In select patients with liver metastasis from gastric cancer, liver resection and RFA showed satisfactory and comparable short-and long-term results. Thus, systemic chemotherapy may not be the only therapeutic option for patients with liver metastasis, and possible liver-directed treatment options for such patients should be considered on an individual basis.

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Section: And Woo Jin Hyungmentioning

confidence: 99%

Liver-directed treatments for liver metastasis from gastric adenocarcinoma: comparison between liver resection and radiofrequency ablation

et al. 2015

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“…[5] These patients were tracked through HES data to determine whether they subsequently had a liver resection within three years of resection of their primary tumour. Details of the data and the analysis are provided in the paper.…”

Section: Methodsmentioning

confidence: 99%

“…Details of the data and the analysis are provided in the paper. [5] Results and Discussion When two or more lines are put on a survival graph it is tempting to make a direct visual comparison. In a fair test of treatments [9] these would be data derived from a randomised controlled trial so that any difference can be reasonably attributed to the difference in treatment and must be tested for how unlikely the difference might have been to chance.…”

Section: Methodsmentioning

confidence: 99%

“…Only after all treatments and evaluations are complete, and further passage of time for re-evaluation and consultation, did one among 37 patients in this analysis have a liver metastasectomy. [5] They are therefore a highly selected group of patients likely to have a better prognosis than the majority of patients with metastases.…”

Section: Methodsmentioning

confidence: 99%

“…[5] It has been cited by 195 related articles. * In peer reviewed studies (for example [6][7][8]) the analysis is cited appropriately.…”

Section: Introductionmentioning

confidence: 99%

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If a picture is worth a thousand words, take a good look at the picture: Survival after liver metastasectomy for colorectal cancer

Morris¹,

Treasure

2017

Cancer Epidemiology

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The authors have no conflicts of interest Structured abstract 150 words Introduction An analysis of NHS data published in by Morris et al in 2010 is widely used as evidence in support of liver metastasectomy for colorectal cancer and its wider application. Recent evidence concerning better overall survival for patients with metastatic colorectal cancer challenges the notional assumptions about what survival would be without metastasectomy. Earlier detection of metastases for local treatments has not resulted in a survival benefit. Materials and MethodsThe interpretation of its central graphical display is critically reviewed and the common limitations of the analysis of registry data and resulting immortal time bias are explored.Results and Discussion Recent evidence, including the 2017 CLOCC trial report make the original interpretation of the analysis suspect. Randomised trials are essential to detect a treatment effect of specific interventions among variable disease progressions, selection bias, and multiple and repeated treatments that are inherent in the management of advanced cancer.

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Best Evidence Supports Annual Surveillance for Resected Colorectal Cancer

Sanoff

2018

JAMA

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Colorectal cancer is unique in solid tumor oncology because surgical resection for patients with solitary or oligometastatic disease can provide long-term disease-free survival, and even cure. [1][2][3][4][5] Largely predicated on the notion that earlier recurrence detection will allow a greater chance of surgery with curative intent, specialty guidelines recommend that patients with stage II or III colorectal cancers should be followed up with a 5-year surveillance program of carcinoembryonic antigen (CEA) testing, computed tomography (CT) scans, and endoscopy. [6][7][8][9][10] These guidelines are supported by multiple prior studies on the role and schedule of surveillance, which suggest surveillance increases curative intent surgical resections and improves overall survival. 11 However, individual trials have used varied testing schedules, employed suboptimal imaging methods, and have been uniformly underpowered. Thus, the optimal postoperative surveillance strategy and the true effect of surveillance on cancer outcomes remain unknown. The articles in this issue of JAMA by Wille-Jørgensen et al 12 and Snyder et al 13 were both designed to evaluate whether higher-intensity testing (ie, more frequent) is more effective than a lower-intensity surveillance strategy as a means of improving the critical outcomes of recurrence detection and overall survival for nonmetastatic colorectal cancer.The COLOFOL trial by Wille-Jørgensen and colleagues 12 was a randomized trial conducted at 24 centers in Denmark, Sweden, and Uruguay that compared a high-and lowintensity surveillance strategy following surgery and adjuvant therapy (as indicated) for stage II or III colorectal cancer. The high-intensity strategy consisted of CEA testing and CT of the chest and abdomen 6, 12, 18, 24, and 36 months after surgical resection. The low-intensity strategy consisted of CEA and CT at 12 and 36 months. The COLOFOL trial was designed to detect a 6% absolute difference in overall survival between the high-and low-intensity strategies at 5 years with 85% power.The results of the COLOFOL trial were null, with no difference in any clinically meaningful end point reported. The intention-to-treat analysis, including the 2509 randomized patients, found no significant difference in 5-year mortality between patients in the high-intensity surveillance group, 13%, compared with the low-intensity group, 14%, with a risk difference of 1.1% (95% CI, −1.6% to 3.8%, P = .43). A per-protocol analysis excluding patients whose surveillance was not con-

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Surgical management and outcomes of colorectal cancer liver metastases

Abstract: The rate of resection of liver metastases increased over the study period but varied significantly across the country. Patients who underwent liver resection had 5-year survival comparable to that of patients with stage III colorectal cancer.

Cited by 320 publications

References 19 publications

Liver-directed treatments for liver metastasis from gastric adenocarcinoma: comparison between liver resection and radiofrequency ablation

Liver-directed treatments for liver metastasis from gastric adenocarcinoma: comparison between liver resection and radiofrequency ablation

If a picture is worth a thousand words, take a good look at the picture: Survival after liver metastasectomy for colorectal cancer

Best Evidence Supports Annual Surveillance for Resected Colorectal Cancer

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