Therapeutic modalities and prognostic factors for primary and secondary liver tumors

Lehnert, Thomas; Otto, Gerd; Herfarth, Christian

doi:10.1007/bf00308635

Cited by 62 publications

(14 citation statements)

References 81 publications

(150 reference statements)

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“…5,6 Patients with potentially resectable but untreated liver metastases have a 3-year survival rate of 20%, and fewer than 3% of patients survive 5 years.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple prognostic parameters after resection of liver metastases have been suggested-for example, number of liver metastases, size of liver metastases, presence of hepatic vein invasion, width of resection margin, disease-free Detection of Disseminated Tumor Cells interval after the primary tumor, stage of the primary tumor, and grading of liver metastases. 5,12,[32][33][34][35][36] Most of those parameters, however, could not be confirmed in other studies or merely predict intrahepatic tumor recurrence. No marker is currently available that can predict extrahepatic tumor recurrence after potentially curative resection.…”

Section: Detection Of Hematogenic Tumor Cell Disseminationmentioning

confidence: 99%

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Detection of Hematogenic Tumor Cell Dissemination in Patients Undergoing Resection of Liver Metastases of Colorectal Cancer

Weitz¹,

Koch²,

Kienle³

et al. 2000

Annals of Surgery

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118

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ObjectiveTo determine the extent of pre-and intraoperative hematogenic tumor cell dissemination in patients undergoing liver resection for metastatic colorectal cancer. Summary Background DataFor patients with hepatic metastases of colorectal cancer, liver resection is the only potentially curative therapy. However, 38% to 53% of patients develop extrahepatic tumor recurrence, probably caused by tumor cells disseminated before or during surgery not detected by current staging systems. MethodsBlood samples harvested before, during, and after surgery from 41 patients and bone marrow samples from 30 patients undergoing resection of liver metastases of colorectal cancer were analyzed for disseminated tumor cells using cytokeratin 20 reverse transcriptase-polymerase chain reaction. ResultsTumor cells were detected in the blood samples of 26 of the 41 patients (63.4%) and in the bone marrow samples of 8 of the 30 patients (26.7%). Tumor cells were detected significantly more often during surgery than before or after surgery. Intraoperative tumor cell dissemination was detected in 41.7% of patients undergoing resection of two or more liver segments but only 14.3% of patients undergoing resection of one liver segment. Compared with resection of primary colorectal cancer, major liver resection carries an increased risk for intraoperative tumor cell dissemination. ConclusionsDetection of disseminated tumor cells in patients undergoing liver resection for metastases of colorectal cancer using cytokeratin 20 reverse transcriptase-polymerase chain reaction might help to identify patients at high risk for tumor recurrence who may benefit from adjuvant therapy. Major liver resection of metastases leads to frequent intraoperative tumor cell shedding, possibly preventable by alternative surgical strategies.The liver is the most common site for metastatic spread of colorectal cancer as a result of the portal venous drainage of the gastrointestinal tract. The frequency of synchronous liver metastases ranges from 15% to 30%, and a similar percentage of patients develop metachronous liver metastases.1-4 For these patients, hepatic resection is the only treatment option offering a reasonable chance of long-term survival. 5,6 Patients with potentially resectable but untreated liver metastases have a 3-year survival rate of 20%, and fewer than 3% of patients survive 5 years.7 Liver resection of metastases of colorectal cancer results in a 3-year survival rate of 30% to 61% and a 5-year survival rate of 16% to 51%, depending on patient selection. 8 -12 However, after resection of liver metastases, 38% to 53% of resected patients develop extrahepatic tumor recurrence, probably caused by the release of neoplastic cells into the systemic circulation either before or during hepatic resection. 8,9,[13][14][15] It has always been suspected, but never proven, that mechanical alteration of the liver during resection of liver metastases leads to massive intraoperative tumor cell shedding into the circulation. Detection of this intraoperative tu...

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“…5,6 Patients with potentially resectable but untreated liver metastases have a 3-year survival rate of 20%, and fewer than 3% of patients survive 5 years.…”

Section: Discussionmentioning

confidence: 99%

Section: Detection Of Hematogenic Tumor Cell Disseminationmentioning

confidence: 99%

Detection of Hematogenic Tumor Cell Dissemination in Patients Undergoing Resection of Liver Metastases of Colorectal Cancer

Weitz¹,

Koch²,

Kienle³

et al. 2000

Annals of Surgery

Self Cite

118

View full text Add to dashboard Cite

show abstract

“…Colorectal cancer frequently metastasizes to the liver, and patients with this condition have a poor clinical outcome with a median survival of untreated metastasis being 6-9 months (range 3.8-21.3 months) [3,27]. The 5-year survival is approximately 1% [28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Radiofrequency Ablation of Colorectal Hepatic Metastases – Initial Experience

White

Roy-Choudhury²,

Breen³

et al. 2004

Dig Surg

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Background and Aim: Most patients with hepatic metastases from colorectal carcinoma are unsuitable for resection. Radiofrequency ablation (RFA) has been applied to such lesions at laparotomy. This study aimed to evaluate the less invasive approach of percutaneous RFA. Method: Patients with unresectable liver metastases identified on cross-sectional imaging were considered for percutaneous RFA either alone or in combination with systemic chemotherapy. Subjects with >6 lesions or lesions of maximum size >70 mm were excluded. Percutaneous RFA was applied under sedation and radiological guidance (CT/US). Treatment effect was determined by follow-up imaging. Actuarial survival was calculated by the Kaplan-Meier analysis. Results: Thirty patients (21 males), median age 74.5 years (range 44–85 years), underwent percutaneous RFA to 56 lesions during 54 treatment sessions. The median size of lesion was 30 mm (range 8–70 mm). Fifteen lesions were treated more than once because of recurrence or incomplete ablation. The median ablation time per lesion was 12 min (range 4.5–36 min). Eleven patients had pre-procedural chemotherapy and 15 patients received chemotherapy after treatment. There was minimal associated morbidity (5.6% of treatments). Median hospital stay per treatment was 1 day (range 1–7). Median actuarial survival from the date of first percutaneous RFA was 22 months (95% CI 12.9–31.1 months). Eleven patients were alive at the time of data collection. Conclusion: Percutaneous RFA is a safe, well-tolerated intervention for unresectable hepatic metastases which can be repeated, if required. The technique may be associated with prolonged survival in this selected group of subjects. Future studies should consider the role of percutaneous RFA either in place of or as an adjunct to palliative chemotherapy.

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“…Schlu È sselwo Èrter: Hochfrequenz-Thermotherapie (HFTT) ± Radiofrequenzablation (RFA) ± Lebertumore ± Metastasen ± Palliation Die Leberteilresektion stellt sowohl bei prima Èren als auch bei sekunda Èren Lebertumoren unter kurativem Ansatz nach wie vor das Verfahren der Wahl dar [6,13,22,24,37,45,48,52,66,67,77,87,91,98]. Bei inoperablen Patienten oder irresektablen Tumoren ist eine operative Therapie jedoch oft nicht mo Èglich.…”

Section: Radiofrequency Ablation Of Liver Tumoursunclassified

“…Schon seit la Èngerer Zeit werden daher alternative, interventionelle Verfahren erprobt, die fu Èr eine lokale Palliation geeignet sind. Hierzu za Èhlen neben der transarteriellen Chemotherapie und Chemoembolisation (TAC/TACE/TAE) [1, 2, 9,12,36,39,44,46,48,88,90] …”

Section: Radiofrequency Ablation Of Liver Tumoursunclassified

Hochfrequenz-Thermoablation bei Lebertumoren

Kormann

Ockert²,

Bunk³

2001

Zentralbl Chir

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Therapeutic modalities and prognostic factors for primary and secondary liver tumors

Cited by 62 publications

References 81 publications

Detection of Hematogenic Tumor Cell Dissemination in Patients Undergoing Resection of Liver Metastases of Colorectal Cancer

Detection of Hematogenic Tumor Cell Dissemination in Patients Undergoing Resection of Liver Metastases of Colorectal Cancer

Percutaneous Radiofrequency Ablation of Colorectal Hepatic Metastases – Initial Experience

Hochfrequenz-Thermoablation bei Lebertumoren

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