Synchronous resection of colorectal cancer and liver metastases: comparative views of colorectal and liver surgeons

Qureshi, M. S.; Goldsmith, Paul; Maslekar, S.; Prasad, Kondapalli Siva; Botterill, I. D.

doi:10.1111/j.1463-1318.2012.02992.x

Cited by 16 publications

(14 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two studies report a delay of about 4 months between liver and rectal surgery in patients undergoing the liver-first approach in which long-course radiotherapy was delivered after liver surgery [14,17]. In the study period our institution had significant concerns performing a liver resection at the same time as a major complex rectal resection, in line with a 2012 review of colorectal and liver surgeons in Great Britain [21]. Conversely, since 55% of the liver resections in the current study were minor wedge resections, simultaneous resection of the rectal cancer and liver metastases in these cases might have been an even more efficient treatment algorithm [7].…”

Section: Discussionmentioning

confidence: 89%

Resection of synchronous liver metastases between radiotherapy and definitive surgery for locally advanced rectal cancer: short‐term surgical outcomes, overall survival and recurrence‐free survival

et al. 2017

View full text Add to dashboard Cite

Aim There is debate as to the correct treatment algorithm sequence for patients with locally advanced rectal cancer with liver metastases. The aim of the study was to assess safety, resectability and survival after a modified 'liver-first' approach.Method This was a retrospective study of patients undergoing preoperative radiotherapy for the primary rectal tumour, followed by liver resection and, finally, resection of the primary tumour. Short-term surgical outcome, overall survival and recurrence-free survival are reported.Results Between 2009 and 2013, 45 patients underwent liver resection after preoperative radiotherapy. Thirtyfour patients (76%) received neoadjuvant chemotherapy, 24 (53%) concomitant chemotherapy during radiotherapy and 17 (43%) adjuvant chemotherapy. The median time interval from the last fraction of radiotherapy to liver resection and rectal surgery was 21 (range 7-116) and 60 (range 31-156) days, respectively. Rectal resection was performed in 42 patients but was not performed in one patient with complete response and two with progressive metastatic disease. After rectal surgery three patients did not proceed to a planned second stage liver (n = 2) or lung (n = 1) resection due to progressive disease. Clavien-Dindo ≥Grade III complications developed in 6.7% after liver resection and 19% after rectal resection. The median overall survival and recurrence-free survival in the patients who completed the treatment sequence (n = 40) were 49.7 and 13.0 months, respectively. Twenty of the 30 patients who developed recurrence underwent further treatment with curative intent. ConclusionThe modified liver-first approach is safe and efficient in patients with locally advanced rectal cancer and allows initial control of both the primary tumour and the liver metastases.Keywords Locally advanced rectal cancer, synchronus colorectal liver metastases, liver-first approach What does this paper add to the literature? The optimal management of patients with locally advanced rectal cancer and synchronous liver metastases is controversial. This study is the first to show that liver resection in the time window between radiotherapy and rectal surgery is a safe and efficient alternative to the traditional liver-first approach.

show abstract

Section: Discussionmentioning

confidence: 89%

Resection of synchronous liver metastases between radiotherapy and definitive surgery for locally advanced rectal cancer: short‐term surgical outcomes, overall survival and recurrence‐free survival

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Colorectal cancer is the second most common cause of cancer‐related deaths in the United States and in the United Kingdom . The most common metastatic site is the liver , with 15–25% of patients having colorectal liver metastasis (CLM) at the time of diagnosis , and another 30–50% of patients developing CLM during their treatment course .…”

Section: Introductionmentioning

confidence: 99%

Synchronous colorectal liver metastasis: A network meta‐analysis review comparing classical, combined, and liver‐first surgical strategies

Kelly

Spolverato

et al. 2014

Journal of Surgical Oncology

127

View full text Add to dashboard Cite

Background In recent years, the management of synchronous colorectal liver metastasis has changed significantly. Alternative surgical strategies to the classical colorectal‐first approach have been proposed. These include the liver‐first and combined resections approaches. The objectives of this review were to compare the short‐ and long‐term outcomes for all three approaches. Methods A systematic review of comparative studies was performed. Evaluated endpoints included surgical outcomes (5‐year overall survival, 30‐day mortality, and post‐operative complications). Pair‐wise and network meta‐analysis (NMA) were performed to compare survival outcomes. Results Eighteen studies were included in this review, reporting on 3,605 patients. NMA and pair‐wise meta‐analysis of the 5‐year overall survival did not show significant difference between the three surgical approaches: combined versus colorectal‐first, mean odds ratio (OR) 1.02 (95% CI 0.8–1.28, P = 0.93); liver‐first versus colorectal‐first, mean OR 0.81 (95% CI 0.53–1.26, P = 0.37); liver‐first versus combined, mean OR 0.80 (95% CI 0.52–1.24, P = 0.41). In addition NMA of the 30‐day mortality among the three approaches also did not observe statistical difference. Analysis of variance showed that mean post‐operative complications of all approaches were comparable (P = 0.51). Conclusion There are considerable differences in the peri‐operative management of synchronous CLM patients. This meta‐analysis demonstrated no clear statistical surgical outcome or survival advantage towards any of the three approaches. J. Surg. Oncol. 2015 111:341–351. © 2014 Wiley Periodicals, Inc.

show abstract

“…Simultaneous resection removes all tumour burdens in one operation and it permits the prompt commencement of adjuvant chemotherapy. Furthermore, it avoids the hepatotoxic side effects of neoadjuvant chemotherapy, which means that simultaneous resection is a safer operation with lesser risk of post-operative liver failure and complications (14)(15)(16)(17). However, some medical facilities do not recommend simultaneous resection if simultaneous resection is needed to treat rectal cancer or in patients undergoing extensive liver resection because it may increase the risk of perioperative complications (14).…”

mentioning

confidence: 99%

“…Furthermore, it avoids the hepatotoxic side effects of neoadjuvant chemotherapy, which means that simultaneous resection is a safer operation with lesser risk of post-operative liver failure and complications (14)(15)(16)(17). However, some medical facilities do not recommend simultaneous resection if simultaneous resection is needed to treat rectal cancer or in patients undergoing extensive liver resection because it may increase the risk of perioperative complications (14). Although several studies have demonstrated the safety of simultaneous liver resection for CRLM, these studies did not evaluate the outcomes of simultaneous liver resection depending on the primary tumor location and type of liver resection (major or minor).…”

mentioning

confidence: 99%

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

Dulundu

Attaallah

Tilki

et al. 2017

BST

View full text Add to dashboard Cite

Synchronous resection of colorectal cancer and liver metastases: comparative views of colorectal and liver surgeons

Abstract: Although significant concerns relating to synchronous resection remain amongst colorectal and liver surgeons, a majority of them felt that synchronous resections could be offered to appropriately selected patients.

Cited by 16 publications

References 39 publications

Resection of synchronous liver metastases between radiotherapy and definitive surgery for locally advanced rectal cancer: short‐term surgical outcomes, overall survival and recurrence‐free survival

Resection of synchronous liver metastases between radiotherapy and definitive surgery for locally advanced rectal cancer: short‐term surgical outcomes, overall survival and recurrence‐free survival

Synchronous colorectal liver metastasis: A network meta‐analysis review comparing classical, combined, and liver‐first surgical strategies

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

Contact Info

Product

Resources

About