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Frühling P, Hellberg K, Ejder P, Strömberg C, Urdzik J, Isaksson B. The prognostic value of C-reactive protein and albumin in patients undergoing resection of colorectal liver metastases. A retrospective cohort study. HPB (Oxford) 2021; 23:970-978. [PMID: 33214053 DOI: 10.1016/j.hpb.2020.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 10/02/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The systemic inflammation-based Glasgow Prognostic Score (GPS) and modified GPS (mGPS), as measured by preoperative C-reactive protein (CRP) and albumin, correlate with poor survival in several cancers. This study evaluates the prognostic value of these scores in patients with colorectal liver metastases (CRLM). METHODS This retrospective study assessed the prognostic role of preoperatively measured GPS and mGPS in patients undergoing liver resection because of CRLM. Clinicopathological data were retrieved from local databases. The prognostic value of GPS and mGPS were compared and a Cox regression model was used to find independent predictors of overall survival. RESULTS In total, 849 consecutive patients between January 2005 and December 2015 were included. Patients with GPS 0 had a median survival of 70 months compared to 49 months in patients with GPS 1, and 27 months in patients with GPS 2. Multivariable analyses showed that GPS 1 (HR = 1.51, 95%CI [1.14-2.01]) and GPS 2 (HR = 2.78, 95%CI [1.79-4.31]), after correction for age >70 years (HR = 1.75 [1.36-2.26]), and extended resection (HR = 2.53, 95%CI[1.79-3.58]), were associated with poor overall survival. CONCLUSION A preoperative GPS is an independent prognostic factor in patients with CRLM, and appears to be a better prognostic tool than mGPS.
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Affiliation(s)
- Petter Frühling
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Katarina Hellberg
- Division of Surgery, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Patric Ejder
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Cecilia Strömberg
- Division of Surgery, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jozef Urdzik
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Bengt Isaksson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Kreidieh M, Mukherji D, Temraz S, Shamseddine A. Expanding the Scope of Immunotherapy in Colorectal Cancer: Current Clinical Approaches and Future Directions. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9037217. [PMID: 32090113 PMCID: PMC7008242 DOI: 10.1155/2020/9037217] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/16/2019] [Indexed: 12/14/2022]
Abstract
The success of immune checkpoint inhibitors (ICIs) in an increasing range of heavily mutated tumor types such as melanoma has culminated in their exploration in different subsets of patients with metastatic colorectal cancer (mCRC). As a result of their dramatic and durable response rates in patients with chemorefractory, mismatch repair-deficient-microsatellite instability-high (dMMR-MSI-H) mCRC, ICIs have become potential alternatives to classical systemic therapies. The anti-programmed death-1 (PD-1) agents, Pembrolizumab and Nivolumab, have been granted FDA approval for this subset of patients. Unfortunately, however, not all CRC cases with the dMMR-MSI-H phenotype respond well to ICIs, and ongoing studies are currently exploring biomarkers that can predict good response to them. Another challenge lies in developing novel treatment strategies for the subset of patients with the mismatch repair-proficient-microsatellite instability-low (pMMR-MSI-L) phenotype that comprises 95% of all mCRC cases in whom treatment with currently approved ICIs has been largely unsuccessful. Approaches aiming at overcoming the resistance of tumors in this subset of patients are being developed including combining different checkpoint inhibitors with either chemotherapy, anti-angiogenic agents, cancer vaccines, adoptive cell transfer (ACT), or bispecific T-cell (BTC) antibodies. This review describes the rationale behind using immunotherapeutics in CRC. It sheds light on the progress made in the use of immunotherapy in the treatment of patients with dMMR-MSI-H CRC. It also discusses emerging approaches and proposes potential strategies for targeting the immune microenvironment in patients with pMMR-MSI-L CRC tumors in an attempt to complement immune checkpoint inhibition.
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Affiliation(s)
- Malek Kreidieh
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Deborah Mukherji
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sally Temraz
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Ali Shamseddine
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Zellweger M, Abdelnour-Berchtold E, Krueger T, Ris HB, Perentes JY, Gonzalez M. Surgical treatment of pulmonary metastasis in colorectal cancer patients: Current practice and results. Crit Rev Oncol Hematol 2018; 127:105-116. [PMID: 29891107 DOI: 10.1016/j.critrevonc.2018.05.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/12/2018] [Accepted: 05/07/2018] [Indexed: 12/13/2022] Open
Abstract
Colorectal cancer (CRC) is a frequently occurring disease, yet diagnosed at a local stage in only 40% of cases. Lung metastases (LM) appear in 5-15% of patients and, left untreated, carry a very poor prognosis. Some CRC patients may benefit from a potentially curative LM resection, but success and benefit are difficult to predict. We discuss prognostic factors of survival after lung metastasectomy in CRC patients under several scenarios (with/ without prior liver metastases; repetitive pulmonary resections). We reviewed all studies (2005-2015) about pulmonary metastases surgical management with curative intent in CRC patients, with a minimum threshold on the number of patients reported (without prior liver metastases: n ≥ 100; with prior resection of liver metastases: n ≥ 50; repetitive thoracic surgery: n ≥ 30). The picture of the prognostic factors of survival is nuanced: surgical management demonstrates clear successes and steady progress, yet there is no single success criterion; stratification of patients and selection bias impact the conclusions. Surgical management of liver and lung metastases may prolong life or cure CRC patients, provided the lesions are fully resected and patients carefully selected. Repeat lung metastasectomy is a safe approach to treat patients in selected cases. In conclusion, there is no standard for surgical management in CRC patients with pulmonary metastases. Patients with isolated unilateral lung metastasis with normal CEA level and no lymph node involvement benefit the most from surgery. Most series report good results in highly selected patients, but instances of long-term disease-free survival remain exceptional.
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Affiliation(s)
- Matthieu Zellweger
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
| | | | - Thorsten Krueger
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
| | - Hans-Beat Ris
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
| | - Jean Yannis Perentes
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
| | - Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
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Okimoto S, Kobayashi T, Tashiro H, Kuroda S, Ishiyama K, Ide K, Abe T, Hashimoto M, Iwako H, Hamaoka M, Honmyo N, Yamaguchi M, Ohdan H. Significance of the Glasgow Prognostic Score for patients with colorectal liver metastasis. Int J Surg 2017; 42:209-214. [PMID: 28483664 DOI: 10.1016/j.ijsu.2017.04.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/14/2017] [Accepted: 04/30/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Systemic inflammation and nutritional status are strongly associated with tumor progression. Inflammation-based prognostic scores, such as the Glasgow Prognostic Score (GPS), reflect these states and are predictive in patients with several types of advanced cancers. The aim of this study was to evaluate the significance of GPS in patients with colorectal liver metastasis (CRLM). PATIENTS AND METHODS Study subjects were 134 patients with CRLM who underwent initial radical liver resection at Hiroshima University Hospital between January 2000 and December 2013. Univariate and multivariate analyses were performed to identify variables associated with overall and recurrence-free survival following liver resection in two groups based on GPS. RESULTS There was no significant relationship between overall survival and GPS. Recurrence-free survival was significantly poorer in patients with GPS 1-2 than in those with GPS 0 (p < 0.01). In multivariate analysis for recurrence-free survival, moderate histologic differentiation, carcinoembryonic antigen level ≥10 ng/mL, and GPS 1-2 were identified as independent prognostic factors. CONCLUSION We suggest that GPS is an important predictor of recurrence following liver resection in patients with CRLM, and it should be considered one of the evaluation criteria for liver resection.
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Affiliation(s)
- Sho Okimoto
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan.
| | - Hirotaka Tashiro
- Department of Surgery, National Hospital Organization Kure Medical Center, 737-0023, 3-1, Kure City, Hiroshima, Japan
| | - Shintaro Kuroda
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan
| | - Kohei Ishiyama
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan
| | - Kentaro Ide
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan
| | - Tomoyuki Abe
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan
| | - Masakazu Hashimoto
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan
| | - Hiroshi Iwako
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan
| | - Michinori Hamaoka
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan
| | - Naruhiko Honmyo
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan
| | - Megumi Yamaguchi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan
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Gong HX, Zhang KB, Wu LM, Baigorri BF, Yin Y, Geng XC, Xu JR, Zhu J. Dual Energy Spectral CT Imaging for Colorectal Cancer Grading: A Preliminary Study. PLoS One 2016; 11:e0147756. [PMID: 26859405 PMCID: PMC4747602 DOI: 10.1371/journal.pone.0147756] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/07/2016] [Indexed: 01/02/2023] Open
Abstract
Objectives To assess the diagnostic value of dual energy spectral CT imaging for colorectal cancer grading using the quantitative iodine density measurements in both arterial phase (AP) and venous phase (VP). Methods 81 colorectal cancer patients were divided into two groups based on their pathological findings: a low grade group including well (n = 13) and moderately differentiated cancer (n = 24), and a high grade group including poorly differentiated (n = 42) and signet ring cell cancer (n = 2). Iodine density (ID) in the lesions was derived from the iodine-based material decomposition (MD) image and normalized to that in the psoas muscle to obtain normalized iodine density (NID). The difference in ID and NID between AP and VP was calculated. Results The ID and NID values of the low grade cancer group were, 14.65±3.38mg/mL and 1.70±0.33 in AP, and 21.90±3.11mg/mL and 2.05± 0.32 in VP, respectively. The ID and NID values for the high grade cancer group were 20.63±3.72mg/mL and 2.95±0.72 in AP, and 26.27±3.10mg/mL and 3.51±1.12 in VP, respectively. There was significant difference for ID and NID between the low grade and high grade cancer groups in both AP and VP (all p<0.001). ROC analysis indicated that NID of 1.92 in AP provided 70.3% sensitivity and 97.7% specificity in differentiating low grade cancer from high grade cancer. Conclusions The quantitative measurement of iodine density in AP and VP can provide useful information to differentiate low grade colorectal cancer from high grade colorectal cancer with NID in AP providing the greatest diagnostic value.
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Affiliation(s)
- Hong-xia Gong
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Ke-bei Zhang
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Lian-Ming Wu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Brian F. Baigorri
- Department of Radiology, The University of North Carolina, Chapel Hill, North Carolina, 27516, United States of America
| | - Yan Yin
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Xiao-chuan Geng
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Jian-Rong Xu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
- * E-mail: (JX); (JZ)
| | - Jiong Zhu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
- * E-mail: (JX); (JZ)
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Mattar RE, Al-alem F, Simoneau E, Hassanain M. Preoperative selection of patients with colorectal cancer liver metastasis for hepatic resection. World J Gastroenterol 2016; 22:567-581. [PMID: 26811608 PMCID: PMC4716060 DOI: 10.3748/wjg.v22.i2.567] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/24/2015] [Accepted: 12/01/2015] [Indexed: 02/06/2023] Open
Abstract
Surgical resection of colorectal liver metastases (CRLM) has a well-documented improvement in survival. To benefit from this intervention, proper selection of patients who would be adequate surgical candidates becomes vital. A combination of imaging techniques may be utilized in the detection of the lesions. The criteria for resection are continuously evolving; currently, the requirements that need be met to undergo resection of CRLM are: the anticipation of attaining a negative margin (R0 resection), whilst maintaining an adequate functioning future liver remnant. The timing of hepatectomy in regards to resection of the primary remains controversial; before, after, or simultaneously. This depends mainly on the tumor burden and symptoms from the primary tumor. The role of chemotherapy differs according to the resectability of the liver lesion(s); no evidence of improved survival was shown in patients with resectable disease who received preoperative chemotherapy. Presence of extrahepatic disease in itself is no longer considered a reason to preclude patients from resection of their CRLM, providing limited extra-hepatic disease, although this currently is an area of active investigations. In conclusion, we review the indications, the adequate selection of patients and perioperative factors to be considered for resection of colorectal liver metastasis.
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Lucchese AM, Kalil AN, Schwengber A, Suwa E, Rolim de Moura GG. Usefulness of intraoperative ultrasonography in liver resections due to colon cancer metastasis. Int J Surg 2015; 20:140-4. [PMID: 26118601 DOI: 10.1016/j.ijsu.2015.06.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 06/11/2015] [Accepted: 06/17/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Intraoperative ultrasonography (IOUS) of the liver has been used both as an aid for intraoperative anatomical definition and for the detection of new lesions. The present study aimed to evaluate the impact of IOUS and to identify factors that can predict the detection of new lesions intraoperatively. METHODS In this observational and prospective study, with a cross-sectional design, patients with colorectal cancer metastases who underwent hepatectomy were selected. Abdominal computed tomography, magnetic resonance imaging, and positron emission tomography were the preoperative evaluation tests. All patients underwent IOUS performed by the same surgeon. The intraoperative findings were compared with the preoperative tests results. RESULTS In total, 56 hepatectomies were evaluated. Half of the patients were men, with a mean age of 57 (30-85) years. New lesions were found intraoperatively in 12 patients (21.4% of cases) and were detected on both palpation and ultrasonography in 11 of these patients. Ultrasonography helped to revise the surgical plans by providing additional information in 35.7% of cases. On multivariate analysis, the presence of more than 4 preoperative nodules was predictive of the intraoperative occurrence of new lesions. CONCLUSIONS IOUS remains the only way to evaluate the relationships between tumors, liver vascular structures, and bile ducts intraoperatively. Alone, IOUS was not useful for identifying new lesions intraoperatively, as all new lesions were also detected on palpation. The number of lesions diagnosed on preoperative tests influenced the probability of identifying new lesions intraoperatively. There may be additional influential factors.
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Affiliation(s)
- Angélica Maria Lucchese
- Department of Surgical Oncology, Hospital Santa Rita, do Complexo Hospitalar da Irmandade Santa Casa de Misericórdia de Porto Alegre (Rio Grande do Sul-Brazil) and Hepatology Post Graduate program (UFCSPA), Rua Dona Laura, 204 - 3 andar, Porto Alegre, RS, CEP: 90430090, Brazil.
| | - Antônio Nocchi Kalil
- Department of Surgical Oncology, Hospital Santa Rita, do Complexo Hospitalar da Irmandade Santa Casa de Misericórdia de Porto Alegre (Rio Grande do Sul-Brazil) and Hepatology Post Graduate program (UFCSPA), Rua Dona Laura, 204 - 3 andar, Porto Alegre, RS, CEP: 90430090, Brazil.
| | - Alex Schwengber
- Department of Surgical Oncology, Hospital Santa Rita, do Complexo Hospitalar da Irmandade Santa Casa de Misericórdia de Porto Alegre (Rio Grande do Sul-Brazil) and Hepatology Post Graduate program (UFCSPA), Rua Dona Laura, 204 - 3 andar, Porto Alegre, RS, CEP: 90430090, Brazil.
| | - Eiji Suwa
- Department of Radiology, Hospital Santa Rita, do Complexo Hospitalar da Irmandade da Santa Casa de Misericórdia de Porto Alegre/UFCSPA, Rua Prof. Annes Dias, 295, Centro Histórico, Porto Alegre, RS, CEP: 90020-090, Brazil.
| | - Gabriel Garcia Rolim de Moura
- Department of Radiology, Hospital Santa Rita, do Complexo Hospitalar da Irmandade da Santa Casa de Misericórdia de Porto Alegre/UFCSPA, Rua Prof. Annes Dias, 295, Centro Histórico, Porto Alegre, RS, CEP: 90020-090, Brazil.
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Vasudevan SP, Cresswell AB, Wright JM, Rees M, Stiff D, Wordley A, Motson RW. Close collaboration between local and specialist multidisciplinary teams allows 'fast-tracking' of patients with colorectal liver metastases. Colorectal Dis 2014; 15:1253-6. [PMID: 23790093 DOI: 10.1111/codi.12323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/19/2013] [Accepted: 04/28/2013] [Indexed: 02/08/2023]
Abstract
AIM The ongoing evolution of treatment strategies for colorectal liver metastases necessarily requires all patients to be reviewed at some point by the specialist hepatobiliary unit. This process can be streamlined through close collaboration with the local colorectal multidisciplinary team (MDT). The study was performed to see if a local colorectal MDT was able to make a correct decision regarding potential operability of liver metastases, by comparing its decision with that of two hepatobiliary surgeons in our referral centre. METHOD CT scans of 38 patients found to have liver metastases from colorectal cancer were anonymized and sent to two hepatobiliary surgeons in our cancer network. They classified them into three categories: R, resectable; C, chemotherapy to downsize then consider resection; U, unresectable. The results were then compared with the opinion of our colorectal MDT, made before the referral to the hepatobiliary surgeons. RESULTS The two independent hepatobiliary surgeons agreed with each other on 35/38 (92%) of CT scans. Our colorectal MDT agreed with the hepatobiliary surgeons in 36/38 (95%) of cases. Only 9 (32%) of the 28 patients deemed suitable on the CT scan by the hepatobiliary surgeons actually had a liver resection. CONCLUSION The results show that a local colorectal MDT is able to make an accurate assessment of the operability of liver metastases. Patients deemed to be inoperable by the colorectal MDT could be 'fast-tracked' to the hepatobiliary MDT with review of imaging only, saving time and resources by avoiding referral of patients who are not suitable for liver resection.
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Affiliation(s)
- S P Vasudevan
- The ICENI Centre, Colchester University Hospital NHS Foundation Trust, Colchester, UK
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Accuracy of water-enema multidetector computed tomography (WE-MDCT) in colon cancer staging: a prospective study. ACTA ACUST UNITED AC 2014; 39:941-8. [DOI: 10.1007/s00261-014-0150-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Herman P, Pinheiro RS, Mello ES, Lai Q, Lupinacci RM, Perini MV, Pugliese V, Andraus W, Coelho FF, Cecconello I, D'Albuquerque LC. Surgical margin size in hepatic resections for colorectal metastasis: impact on recurrence and survival. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2013; 26:309-314. [PMID: 24510040 DOI: 10.1590/s0102-67202013000400011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/11/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Approximately 50% of the patients with a colorectal tumor develop liver metastasis, for which hepatectomy is the standard care. Several prognostic factors have been discussed, among which is the surgical margin. This is a recurring issue, since no consensus exists as to the minimum required distance between the metastatic nodule and the liver transection line. AIM To evaluate the surgical margins in liver resections for colorectal metastases and their correlation with local recurrence and survival. METHODS A retrospective study based on the review of the medical records of 91 patients who underwent resection of liver metastases of colorectal cancer. A histopathological review was performed of all the cases; the smallest surgical margin was verified, and the late outcome of recurrence and survival was evaluated. RESULTS No statistical difference was found in recurrence rates and overall survival between the patients with negative or positive margins (R0 versus R1); likewise, there was no statistical difference between subcentimeter margins and those greater than 1 cm. The disease-free survival of the patients with microscopically positive margins was significantly worse than that of the patients with negative margins. The uni- and multivariate analyses did not establish the surgical margin (R1, narrow or less than 1 cm) as a risk factor for recurrence. CONCLUSION The resections of liver metastases with negative margins, independently of the margin width, had no impact on tumor recurrence (intra- or extrahepatic) or patient survival.
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Jönsson K, Gröndahl G, Salö M, Tingstedt B, Andersson R. Repeated Liver Resection for Colorectal Liver Metastases: A Comparison with Primary Liver Resections concerning Perioperative and Long-Term Outcome. Gastroenterol Res Pract 2012; 2012:568214. [PMID: 22973305 PMCID: PMC3437631 DOI: 10.1155/2012/568214] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 06/07/2012] [Indexed: 12/29/2022] Open
Abstract
Introduction. 60% of patients operated for colorectal liver metastases (CRLM) will develop recurrent disease and some may be candidates for a repeated liver resection. The study aimed to evaluate differences in intraoperative blood loss and complications comparing the primary and the repeated liver resection for metastases of colorectal cancer (CRC), as well as to evaluate differences in long-time follow-up. Method. 32 patients underwent 34 repeated liver resections due to recurrence of CRLM an studied retrospectively to identify potential differences between the primary and the repeat resections. Results. There was no 30-day postoperative mortality or postoperative hospital deaths. The median blood loss at repeat resection (1850 mL) was significantly (P = 0.014) higher as compared to the primary liver resection (1000 mL). This did not have any effect on the rate of complications, even though increased bleeding in itself was a risk factor for complications. There were no differences in survival at long-term follow-up. Discussion. A repeated liver resection for CRLM was associated with an increased intraoperative bleeding as compared to the first resection. Possible explanations include presence of adhesions, deranged vascular anatomy, more complicated operations and the effects on the liver by chemotherapy following the first liver resection. 30 out of 32 patients had only one reresection of the liver.
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Affiliation(s)
- Kristoffer Jönsson
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital Lund, Lund SE-22185, Sweden
| | - Gerd Gröndahl
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital Lund, Lund SE-22185, Sweden
| | - Martin Salö
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital Lund, Lund SE-22185, Sweden
| | - Bobby Tingstedt
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital Lund, Lund SE-22185, Sweden
| | - Roland Andersson
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital Lund, Lund SE-22185, Sweden
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Liver abscess after liver metastasectomy is a poor prognostic factor in patients with colorectal cancer. J Gastrointest Surg 2011; 15:1798-806. [PMID: 21786059 DOI: 10.1007/s11605-011-1642-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 07/13/2011] [Indexed: 01/31/2023]
Abstract
PURPOSE More and more complications of extensive hepatic resection are being encountered in patients treated for liver metastases from colorectal cancer. This study aimed to determine the impact of liver abscess after hepatic resection on overall survival (OS) and the role of adjuvant chemotherapy. METHODS This is a retrospective study of 252 patients treated by liver metastasectomy between 2001 and 2010. RESULTS The 5-year survival rate was 55.8%. Twenty-one (8.3%) patients developed liver abscess after liver metastasectomy. Multivariate analysis identified the size of liver metastasis, surgical margin, and the presence of liver abscess as significant prognostic factors. Patients (whether or not they developed liver abscess after hepatic resection) had similar progression-free survival (median, 9.8 vs. 12.4 months, P = 0.476), but patients who developed liver abscess had significantly shorter OS (26.6 vs. 76.0 months, P = 0.004). Subsequent adjuvant therapy significantly improved OS in these patients (16.9 vs. 38.5 months, P = 0.032). CONCLUSIONS Liver abscess after liver metastasectomy is an independent prognostic factor, and adjuvant chemotherapy is warranted in those patients who develop liver abscess.
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Pathak S, Jones R, Tang JMF, Parmar C, Fenwick S, Malik H, Poston G. Ablative therapies for colorectal liver metastases: a systematic review. Colorectal Dis 2011; 13:e252-65. [PMID: 21689362 DOI: 10.1111/j.1463-1318.2011.02695.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM The standard treatment for colorectal liver metastases (CRLM) is surgical resection. Only 20-30% of patients are deemed suitable for surgery. Recently, much attention has focused on ablative therapies either to treat unresectable CRLM or to extend the margins of resectability. This review aims to assess the long-term outcome and complication rates of various ablative therapies used in the management of CRLM. METHOD A literature search was performed of electronic databases including Medline, Cochrane Collaboration Library and the National Library of Medicine's ClinicalTrials.gov. Inclusion criteria were ablation for CRLM with minimum 1 year follow-up and >10 patients, published between January 1994 and January 2010. RESULTS In all, 226 potentially relevant studies were identified, of which 75 met the inclusion criteria. Cryotherapy (26 studies) had local recurrence rates of 12-39%, with mean 1-, 3- and 5-year survival rates of 84%, 37% and 17%. The major complication rate ranged from 7% to 66%. Microwave ablation (13 studies) had a local recurrence rate of 5-13%, with a mean 1-, 3- and 5-year survival of 73%, 30% and 16%, and a major complication rate ranging from 3% to 16%. Radiofrequency ablation (36 studies) had a local recurrence rate of 10-31%, with a mean 1-, 3- and 5-year survival of 85%, 36% and 24%, with major complication rate ranging from 0% to 33%. CONCLUSION Ablative therapies offer significantly improved survival compared with palliative chemotherapy alone with 5-year survival rates of 17-24%. Complication rates amongst commonly used techniques are low.
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Affiliation(s)
- S Pathak
- Department of Hepatobiliary Surgery, Aintree University NHS Foundation Trust, Liverpool, UK.
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14
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Shah AJ, Callaway M, Thomas MG, Finch-Jones MD. Contrast-enhanced intraoperative ultrasound improves detection of liver metastases during surgery for primary colorectal cancer. HPB (Oxford) 2010; 12:181-7. [PMID: 20590885 PMCID: PMC2889270 DOI: 10.1111/j.1477-2574.2009.00141.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Computed tomography (CT) is the most common staging investigation in colorectal cancer (CRC). Up to 25% of patients are found to have previously undetected hepatic lesions when intraoperative ultrasound (IOUS) of the liver is used during CRC resection. We aimed to assess the ability of IOUS to detect additional liver lesions/metastases at primary colorectal resection, and to evaluate whether contrast-enhanced IOUS (CE-IOUS) improves the detection and characterization of hepatic lesions. METHODS We performed a single-centre, prospective pilot study. At CRC resection, patients underwent IOUS of the liver. Contrast-enhanced IOUS of the liver was undertaken using i.v. sulphur hexafluoride micro-bubbles (SonoVue, 4.8 ml). Findings of CT, non-enhanced IOUS and CE-IOUS were compared. Changes in staging or management were noted. Additional lesions were corroborated with iron oxide magnetic resonance imaging (MRI). RESULTS Among 21 patients, IOUS demonstrated additional lesions in seven (33%). Contrast altered the diagnosis of non-enhanced IOUS in four (20%) and changed the management strategy in three (14%) patients. Thus, IOUS in combination with the contrast agent altered the intraoperative or postoperative management plan in four patients. CONCLUSIONS In the first study of its kind, early results suggest that the ability of IOUS to detect additional metastases is improved by CE-IOUS, and that this may impact on surgical staging and management.
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Affiliation(s)
- Ankur J Shah
- Department of Hepato-Pancreato-Biliary Surgery, Bristol Royal InfirmaryBristol, UK
| | - Mark Callaway
- Department of Radiology, Bristol Royal InfirmaryBristol, UK
| | - Michael G Thomas
- Department of Colorectal Surgery, Bristol Royal InfirmaryBristol, UK
| | - Meg D Finch-Jones
- Department of Hepato-Pancreato-Biliary Surgery, Bristol Royal InfirmaryBristol, UK
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15
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Ridereau-Zins C, Aubé C, Luet D, Vielle B, Pilleul F, Dumortier J, Gandon Y, Heresbach D, Beziat C, Bailly F, DeBilly M, Carbonnel F, Pierredon-Foulongne MA, Bismuth M, Chretien JM, Lebigot J, Pessaux P, Valette PJ. Assessment of water enema computed tomography: an effective imaging technique for the diagnosis of colon cancer. ACTA ACUST UNITED AC 2009; 35:407-13. [DOI: 10.1007/s00261-009-9536-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 04/30/2009] [Indexed: 01/16/2023]
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16
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Malik HZ. The case for neo-adjuvant chemotherapy. For. Ann R Coll Surg Engl 2008; 90:452-4. [PMID: 18777621 PMCID: PMC2647234 DOI: 10.1308/003588408x321620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hassan Z Malik
- Department of Hepatobiliary Surgery, University Hospital Aintree Hospitals NHS Trust, Liverpool, UK.
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17
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Byrne C, Griffin A, Blazeby J, Conroy T, Efficace F. Health-related quality of life as a valid outcome in the treatment of advanced colorectal cancer. Eur J Surg Oncol 2007; 33 Suppl 2:S95-104. [PMID: 18039559 DOI: 10.1016/j.ejso.2007.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 10/10/2007] [Indexed: 11/12/2022] Open
Abstract
With the recent trend of improved survival, there has been a marked interest in reviewing and refining the contribution of health related quality of life (HRQoL) outcome measures of treatment in advanced colorectal cancer. However, if HRQoL data are going to be of clinical value and help both physicians and patients make decisions there is a need for a consensus on both the design and methods of measurement of HRQoL in clinical trials, and an acknowledgement of the interpretation of the outcomes in clinical practice. Whilst it is encouraging to find that the quality of HRQoL measurement in clinical research has improved significantly over the last fifteen years, with a growing number of trial-based HRQoL studies, there is still the potential to improve the use of HRQoL in clinical decision making in advanced colorectal cancer. There is also the need to further refine measurement of HRQoL to provide useful data specific to these patients. It is anticipated that developments such as the liver metastases module EORTC (QLQ-LMC21) questionnaire will increase the sensitivity to change of the generic cancer measure, the EORTC QLQ-C30 and will provide essential HRQoL information regarding the use of treatments in both the curative and palliative settings. Furthermore, easy to use simple tools such as the "minimum standard checklist for evaluating HRQoL outcomes in cancer clinical trials" might be of help in guiding investigators on the basis of minimum criteria.
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Affiliation(s)
- C Byrne
- Liverpool Supra-Regional Hepatobiliary Unit, University Hospital Aintree, Liverpool, UK.
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18
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Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 2006; 94:982-99. [PMID: 16538219 PMCID: PMC2361241 DOI: 10.1038/sj.bjc.6603033] [Citation(s) in RCA: 623] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
No consensus on the indications for surgical resection of colorectal liver metastases exists. This systematic review has been undertaken to assess the published evidence for its efficacy and safety and to identify prognostic factors. Studies were identified by computerised and hand searches of the literature, scanning references and contacting investigators. The outcome measures were overall survival, disease-free survival, postoperative morbidity and mortality, quality of life and cost effectiveness, and a qualitative summary of the trends across all studies was produced. Only 30 of 529 independent studies met all the eligibility criteria for the review, and data on 30-day mortality and morbidity only were included from a further nine studies. The best available evidence came from prospective case series, but only two studies reported outcomes for all patients undergoing surgery. The remainder reported outcomes for selected groups of patients: those undergoing hepatic resection or those undergoing curative resection. Postoperative mortality rates were generally low (median 2.8%). The majority of studies described only serious postoperative morbidity, the most common being bile leak and associated perihepatic abscess. Approximately 30% of patients remained alive 5 years after resection and around two-thirds of these are disease free. The quality of the majority of published papers was poor and ascertaining the benefits of surgical resection of colorectal hepatic metastases is difficult in the absence of randomised trials. However, it is clear that there is group of patients with liver metastases who may become long-term disease- free survivors following hepatic resection. Such survival is rare in apparently comparable patients who do not have surgical treatment. Further work is needed to more accurately define this group of patients and to determine whether the addition of adjuvant treatments results in improved survival.
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Affiliation(s)
- P C Simmonds
- Cancer Research UK Clinical Centre, MP824, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - J N Primrose
- University Surgery, F Level Centre Block (MP816), Southampton General Hospital, Southampton SO16 6YD, UK
- University Surgery, F Level Centre Block (MP816), Southampton General Hospital, Southampton SO16 6YD, UK. E-mail:
| | - J L Colquitt
- Cancer Research UK Clinical Centre, MP824, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - O J Garden
- Department of Clinical and Surgical Sciences, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, Scotland EH16 4SA, UK
| | - G J Poston
- Department of Surgery, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK
| | - M Rees
- Hepatobiliary Surgery Unit, North Hampshire Hospital, Aldermaston Road, Basingstoke RG24 9NA, UK
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19
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Velasco JM, Hieken TJ, Yamin N, Doolas A. Colorectal Hepatic Metastasis. Surg Oncol 2006. [DOI: 10.1007/0-387-21701-0_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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20
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Holmer C, Lehmann KS, Risk J, Roggan A, Germer CT, Reissfelder C, Isbert C, Buhr HJ, Ritz JP. Colorectal tumors and hepatic metastases differ in their optical properties—relevance for dosimetry in laser-induced interstitial thermotherapy. Lasers Surg Med 2006; 38:296-304. [PMID: 16526042 DOI: 10.1002/lsm.20300] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The therapeutic application of laser light is a promising alternative to surgical resection of colorectal liver metastases. The extent of tumor destruction achieved by this strategy depends primarily on light distribution in the target tissue. Knowledge about optical properties is necessary to predict light distribution in the tissue for careful irradiation planning. The aim of this study was to compare the optical behavior of healthy colon tissue with that of colorectal carcinomas and their hepatic metastases in the native and coagulated state in order to test the effect of malignant degeneration, metastasis, and thermal coagulation on optical parameters. MATERIALS AND METHODS Ninety tissue samples were taken from patients with a colorectal carcinoma and concomitant liver metastases: healthy colon tissue (n = 30); colon carcinoma (n = 30); liver metastases (n = 30). Optical properties were measured according to the single integrating sphere principle in the native state and after thermal coagulation in the wavelength range of 800-1,100 nm and analyzed by inverse Monte Carlo simulation. RESULTS The highest optical penetration depth for all tissue types was obtained at the end of the spectral range investigated. The highest penetration depths of 4.13 mm (healthy colon), 7.47 mm (colon carcinoma tissue), and 4.08 (liver metastases) were at 1,060 nm, although the values decreased significantly after thermal coagulation. Comparing healthy colon-to-colon carcinoma always revealed a significantly lower absorption and scattering coefficient in the tumor tissue. This resulted in a higher optical penetration depth of the laser light in the colon carcinoma tissue (P < 0.05). A direct comparison disclosed no agreement between the optical properties of the primary tumor and the liver metastases. In the native state, colon carcinoma tissue had a lower scattering coefficient (P < 0.05), higher anisotropy factor, and optical penetration depth than liver metastases (P < 0.05). The absorption coefficient did not differ significantly. The differences in the native state were equalized by tissue coagulation. CONCLUSIONS Colon carcinoma tissue has a higher optical penetration depth than healthy colon tissue, which speaks in favor of tumor selectivity for interstitial laser application, since large treatment volumes can be obtained in the tumor. The lack of agreement between primary tumors and their concomitant liver metastases indicates a modification of optical behavior through metastasis. Thermal coagulation of tissue leads to changes in the optical properties, which are clearly less pronounced in carcinoma tissue. The data obtained in this study clearly show that an individual irradiation schedule is necessary for effective and safe dosimetry in laser-induced thermotherapy (LITT).
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Affiliation(s)
- Christoph Holmer
- Department of General, Vascular and Thoracic Surgery, Charité-Campus Benjamin Franklin, Berlin, Germany
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21
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Abstract
Colorectal cancer remains the second commonest cause of death from cancer in Western society. Nearly half of all patients will develop liver metastases and many will die with disease confined to the liver. The accepted modern definitions of resectability now mean that over twenty per cent of patients are now resectable (with operative mortality of >2%) with curative intent, and nearly one third will be alive, disease free, five years later. The use of additional techniques such as radiofrequency ablation may bring many more patients the possibility of long term survival. The introduction of new chemotherapy regimens, including those based on oxaliplatin may convert one third of non-resectable patients to resectability with curative intent. Therefore, in 2004 nearly one third of patients with disease confined to the liver can now look forward to possibly curative liver surgery.
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Affiliation(s)
- Graeme J Poston
- Liverpool Supra-Regional Hepato-Biliary Center, University Hospital, Aintree, Liverpool L9, UK; Royal Liverpool University Hospital, Liverpool, UK.
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22
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Yu B, Li SY, An P, Zhang YN, Liang ZJ, Yuan SJ, Cai HY. Comparative study of proteome between primary cancer and hepatic metastatic tumor in colorectal cancer. World J Gastroenterol 2004; 10:2652-6. [PMID: 15309713 PMCID: PMC4572187 DOI: 10.3748/wjg.v10.i18.2652] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To identify the differential proteins associated with colorectal cancer genesis and hepatic metastasis.
METHODS: Hydrophobic protein samples were extracted from normal colorectal mucosa, primary cancer lesion and hepatic metastatic foci of colorectal cancer. With two-dimensional electrophoresis and image analysis, differentially expressed protein spots were detected, and the proteins were identified by matrix assisted laser desorption/ionization-time of flight-mass spectrometry and peptide mass fingerprint analysis.
RESULTS: Significant alterations of the proteins in number and expression levels were discovered in primary cancer and hepatic metastatic foci, the expression of a number of proteins was lost in 25-40 ku, but protein spots was increased in 14-21 ku, compared with normal mucosa. Nine differentially expressed protein spots were identified. Three proteins expressed in normal mucosa, but lost in primary cancer and hepatic metastasis, were recognized as calmodulin, ribonuclease 6 precursor and mannosidase-α. Proapolipoprotein was expressed progressively from normal mucosa to primary cancer and hepatic metastasis. The differentially expressed protein of beta-globin was found in normal mucosa and hepatic metastatic tumor, but lost in primary cancer lesion. Cdc 42, a GTP-binding protein, was identified in hepatic metastasis. The protein spots of C4 from primary cancer, M7 and M9 from hepatic metastasis had less homology with the proteins in database.
CONCLUSION: Variations of hydrophobic protein expression in colorectal cancer initiation and hepatic metastasis are significant and can be observed with two-dimensional electrophoresis. The expression of calmodulin, ribonuclease 6 precursor and mannosidase-α is lost but the expression of proapolipoprotein is enhanced which is associated with colorectal cancer genesis and hepatic metastasis. Cdc 42 and beta-globin are expressed abnormally in hepatic metastasis. Protein C4, M7 and M9 may be associated with colorectal cancer genesis and hepatic metastasis.
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Affiliation(s)
- Bo Yu
- Department of General Surgery, General Hospital of Beijing Military Command, Beijing 100700, China.
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23
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Karamarković AR, Stefanović B, Djukić VR, Mihalilović V, Popović N. [Anatomic segmental resection of the liver in surgical treatment of colorectal metastatic lesions]. SRP ARK CELOK LEK 2004; 131:375-81. [PMID: 15058216 DOI: 10.2298/sarh0310375k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The prime role of hepatic resection in the management of colorectal cancer metastatic to the liver is firmly established. At least a third of patients who undergo liver resection for colorectal metastases can expect to survive five years. Since 1999, 106 hepatic metastases were resected in 42 patients (synchr. 8, metachr. 34, pts.). We performed 12 monosegmentectomies (S2-S8), 4 bisegmentectomies (S4b, S5 and S5, S6), 6 sectorectomies (right posterior, left paramedian, left lateral), 3 polysegmentectomies (S4b, S5, S6), 8 bilateral sectionectomies (S2, S3 and S6, S7) and in 9 cases multiple segmentectomies. In 4 cases initially unresectable colorectal metastases were downstaged by transcatheter HAI regional chemotherapy (Implantoflx), and after that successfully resected. We favour vascular inflow occlusion through selective division of appropriate portal pedicle at the porta hepatis or by transparenchymal approach. Median blood loss was 330 +/- 160 ml. The complication rate amounted to 9.52% (bile fistula, abscess collection). No method related lethality occurred. During the follow-up period we registered tumor recurrence rate of 19.1% (8 pts.), of which two patients were subjected to liver re-resection. Overall 3-year survival rate (Kaplan-Meier) is 38.9%. Multivariate analysis shows a significant correlation between 3-year survival and solitary (p-0.031) and unilobar metastases (p-0.014).
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24
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Liang P, Dong B, Yu X, Yang Y, Yu D, Su L, Xiao Q, Sheng L. Prognostic Factors for Percutaneous Microwave Coagulation Therapy of Hepatic Metastases. AJR Am J Roentgenol 2003; 181:1319-25. [PMID: 14573427 DOI: 10.2214/ajr.181.5.1811319] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Microwave-induced tissue coagulation is a new approach for the local ablation of hepatic metastases. The purposes of the study were to analyze therapeutic results and those influencing factors that might be used to predict survival after percutaneous microwave coagulation therapy. SUBJECTS AND METHODS. From July 1995 to March 2002, 74 patients with 149 hepatic metastases were treated with percutaneous microwave coagulation therapy under sonographic guidance. The largest metastasis in each patient ranged from 0.7 to 6.8 cm (mean, 3.12 cm; SD, 1.81 cm). Survival rates and influencing factors were analyzed. RESULTS The cumulative survival rates of all 74 patients were 91.4% at 1 year, 59.5% at 2 years, 46.4% at 3 years, 29% at 4 years, and 29% at 5 years. Patient age (p = 0.46) and sex (p = 0.12) and site of primary malignancies (p = 0.58) were not related to prognosis, whereas tumor grade (p = 0.01), number of metastases (p = 0.00), tumor size (p = 0.03), and local recurrence or new metastasis (p = 0.00) significantly affected survival as single independent factors. Multivariate analysis revealed that tumor grade (p = 0.03), number of metastases (p = 0.025), and local recurrence or new metastasis (p = 0.04) each had a significant effect on survival. No severe complications occurred. CONCLUSION The probability of long-term survival for patients with one or two metastases, well-differentiated tumors, and without recurrence or new metastasis may be significantly higher than for other patients.
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Affiliation(s)
- Ping Liang
- Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Rd., Beijing, 100853 China
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25
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Walsh L, Poston G. The potential to increase curative liver resection rates in metastatic colorectal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2002; 28:812-4. [PMID: 12477470 DOI: 10.1053/ejso.2002.1273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- L Walsh
- Department of Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
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26
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Solbiati L, Ierace T, Tonolini M, Osti V, Cova L. Radiofrequency thermal ablation of hepatic metastases. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 2001; 13:149-158. [PMID: 11369526 DOI: 10.1016/s0929-8266(01)00127-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Percutaneous radiofrequency (RF) ablation is a promising therapeutic option for liver metastases, which may result in prolonged survival and chance for cure. Recent technological advancements provide larger coagulation volumes, allowing treatment of medium- and large-size metastases. Candidates are patients with metachronous liver metastases from colorectal or other primary cancers, in whom surgery is contraindicated and with one to four nodules each smaller than approx. 4 cm. We treated 109 patients with 172 colorectal metastases in the liver. Local control was obtained in 70.4% of lesions. Recurrence was significantly more frequent in lesions >3 cm. One major complication occurred (0.6% of sessions), a large bowel perforation requiring surgery. Seven minor complications did not require therapy. New metastases developed at follow-up in 50.4% of patients. Survival rates are 67% and 33% after 2 and 3 years, respectively; estimated median survival being 30 months. RF ablation advantages include minimal-invasiveness (no mortality, significantly lower complications), reduced costs and hospital stays compared to surgery, feasibility in non-surgical candidates, and the potential of repeated treatment if local recurrence occurs or new metastases develop.
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Affiliation(s)
- L Solbiati
- Department of Radiology, General Hospital, 21052, Busto Arsizio, Italy.
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27
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Alexander HR, Bartlett DL, Libutti SK. Current status of isolated hepatic perfusion with or without tumor necrosis factor for the treatment of unresectable cancers confined to liver. Oncologist 2001; 5:416-24. [PMID: 11040278 DOI: 10.1634/theoncologist.5-5-416] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Metastatic or primary unresectable cancers confined to the liver are the sole or life-limiting component of disease for many patients with colorectal cancer, ocular melanoma, neuroendocrine tumors or primary colangio- or hepatocellular carcinomas. A number of regional treatment strategies including infusional chemotherapy and local ablative therapy are under clinical development and attest to the difficulty in adequately treating this condition. Isolated hepatic perfusion (IHP) was first clinically applied over 40 years ago, but because of its technical complexity, the attendant potential morbidity, and the lack of documented efficacy, it has not gained widespread application. In light of the remarkable antitumor activity with isolated limb perfusion with tumor necrosis factor (TNF) and melphalan in patients with unresectable extremity sarcoma or in transit melanoma, this regimen has been administered via IHP at several centers worldwide for unresectable liver cancers. IHP with TNF and melphalan can result in significant regression of advanced refractory cancers confined to the liver and, with additional clinical development, will most likely be a more routinely considered option for patients with this condition.
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Affiliation(s)
- H R Alexander
- Surgical Metabolism Section, Surgery Branch, Division of Clinical Sciences, National Cancer Institute/National Institutes of Health, Bethesda, Maryland 20892, USA
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28
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Yang JL, Seetoo DQ, Wang Y, Ranson M, Berney CR, Ham JM, Russell PJ, Crowe PJ. Urokinase-type plasminogen activator and its receptor in colorectal cancer: independent prognostic factors of metastasis and cancer-specific survival and potential therapeutic targets. Int J Cancer 2000; 89:431-9. [PMID: 11008205 DOI: 10.1002/1097-0215(20000920)89:5<431::aid-ijc6>3.0.co;2-v] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Urokinase-type plasminogen activator (uPA) and its receptor (uPAR), plasminogen (Plg), and plasminogen activator inhibitors-1 and -2 (PAI-1 and PAI-2) have been observed in many cancers and may contribute to progression and metastasis. In our study, we examined the expression of the 5 proteins by immunohistochemistry in 59 consecutive primary colorectal cancers (CRC) and correlated the protein expression with patient outcome. In addition, we determined the effect of down-regulation of uPAR on the invasive/metastatic capability of CRC cells, by measuring antisense-uPAR transfected HCT116 and control cell lines, in terms of uPAR expression, uPA-binding activity, invasiveness through Matrigel in vitro and metastasis after cecal orthotopic implantation in nude mice in vivo. We found that higher expression of uPA or uPAR in primary tumor tissues was positively correlated with distant metastasis of CRC (Mann-Whitney, p < 0.02) and negatively correlated with both patient overall survival (OS) and cancer-specific survival (CSS; Cox model, p < 0.04). The prognostic value of uPA and uPAR for both OS and CSS was independent of other variables (multivariate Cox model, p < 0. 007). Antisense-uPAR transfected HCT116 cells, which expressed significantly lower levels of total cellular and cell surface uPAR proteins and uPA-binding activity compared with either wild-type or cells transfected with vector alone (Bonferroni, p < 0.05/3), consistently showed decreased invasiveness through Matrigel (Bonferroni, p < 0.05/3) and decreased metastasis formation in nude mice (Fisher, p < 0.05). Our data suggest that uPAR and uPA are independent prognostic factors in CRC; anti-uPAR treatment, which affects both uPAR and uPA levels, may have potential for new treatment of the disease.
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Affiliation(s)
- J L Yang
- Department of Surgery, Faculty of Medicine of University of New South Wales, Prince of Wales Hospital, Randwick, Australia.
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29
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Cromheecke M, de Jong KP, Hoekstra HJ. Current treatment for colorectal cancer metastatic to the liver. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1999; 25:451-63. [PMID: 10527592 DOI: 10.1053/ejso.1999.0679] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Surgery is currently the only available treatment option which offers the potential for cure for patients with liver metastases from colorectal cancer. Of those who undergo a potentially curative operation for their primary tumour but subsequently recur, almost 80% will develop evidence of metastatic disease within the liver. Greater experience and improvements in technique in liver surgery, with an increasingly aggressive surgical approach to metastatic colorectal cancer to the liver, has resulted in prolonged disease-free survival with 5-year rates varying from 21% to 48%. In order to increase these numbers further and to treat patients not eligible for surgical therapy, new treatment modalities and strategies have been developed. This review presents an update of the current treatment for colorectal disease metastatic to the liver.
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Affiliation(s)
- M Cromheecke
- Department of Surgery, Division of Surgical Oncology, Groningen, The Netherlands
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30
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Zeh H, Choyke PL, Alexander HR, Bartlett DL, Libutti SK, Chang R, Summers RM. Gadolinium-enhanced 3D MRA prior to isolated hepatic perfusion for metastases. J Comput Assist Tomogr 1999; 23:664-9. [PMID: 10524842 DOI: 10.1097/00004728-199909000-00003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Isolated hepatic perfusion (IHP) is a new treatment for patients with isolated unresectable liver metastases, which can result in a partial or complete response in approximately 75% of patients. Preoperative knowledge of hepatic arterial anatomy is important to adequately perfuse the liver. Digital subtraction angiography (DSA) is currently used to identify the hepatic arterial anatomy. The purpose of this study was to determine if MR angiography (MRA) could replace DSA prior to IHP. METHOD Twenty-seven patients scheduled to undergo IHP underwent MRA with a contrast-enhanced 3D time-of-flight gradient echo sequence. Both maximal intensity projections (MIPs) and source coronal images were used to evaluate the images. The results of the MRA were interpreted by two readers who were blinded to the surgical results. The first 17 patients also underwent DSA, and a separate comparison was made with those results. Anatomy was characterized as either normal hepatic arteries (NHAs), normal vasculature with an accessory left hepatic artery (aLHA), or a replaced right hepatic artery (rRHA). RESULTS MRA correctly detected all 22 patients with NHAs but also identified 6 aLHAs, of which only 2 were confirmed surgically. MRA correctly detected all five rRHAs. MIP images alone accurately depicted the hepatic arterial anatomy in only 9 of 27 (33%), usually because significant vessels were not visualized or their origin could not be determined. Source coronal images were required to accurately determine the anatomy in all patients. Among the 17 patients who underwent DSA, MRA detected 14 of 14 with NHA and 3 of 3 with rRHA. Six aLHAs were identified by MRA and five were confirmed by DSA. CONCLUSION Enhanced 3D MRA is an accurate method of depicting the hepatic arterial supply. In comparison to surgery, MRA overestimates the number of aLHAs, but this may be because these small vessels are not detected at surgery. Based on the results of this study, DSA has been replaced by MRA in the planning of IHP at our institution. A better display of MRA images is needed as MIP images were usually insensitive for the small caliber arteries supplying the liver.
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Affiliation(s)
- H Zeh
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Ambiru S, Miyazaki M, Ito H, Nakagawa K, Shimizu H, Nakajima N. Adjuvant regional chemotherapy after hepatic resection for colorectal metastases. Br J Surg 1999; 86:1025-31. [PMID: 10460638 DOI: 10.1046/j.1365-2168.1999.01168.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study explored the possibility of achieving a better survival rate and reduced recurrence in the remaining liver in patients with colorectal hepatic metastases undergoing hepatic resection. Adjuvant postoperative regional chemotherapy was administered via the hepatic artery or the portal vein. METHODS A retrospective study was performed on 174 patients after hepatic resection for colorectal metastases. These comprised 78 patients who had hepatic artery infusion (HAI) chemotherapy (HAI group), 30 who had portal vein infusion (PVI) chemotherapy (PVI group) and 66 who had no regional chemotherapy (resection alone group). The three groups were compared with one another in terms of complications, survival rate and patterns of recurrence. RESULTS Severe complications did not occur at any point during adjuvant HAI or PVI chemotherapy. The 5-year disease-free survival rate of patients in the HAI, PVI and resection alone groups were 35, 13 and 9 per cent respectively, including six hospital deaths. Patients in the HAI group showed significantly improved recurrence rates in the remaining liver compared with the resection alone group (P = 0.03), and more prolonged disease-free and overall survival than those in the PVI (P = 0.01 and P = 0.02 respectively) and resection alone (P = 0.0001 and P = 0.0006 respectively) groups. CONCLUSION This study suggests that adjuvant HAI chemotherapy after hepatic resection may have therapeutic potential for improved management of patients with colorectal metastases.
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Affiliation(s)
- S Ambiru
- First Department of Surgery, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
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Bekradda M, Cvitkovic E. New possibilities in chemotherapy for colorectal cancer. Ann Oncol 1999. [DOI: 10.1093/annonc/10.suppl_6.s105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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