A systematic review of two‐stage hepatectomy in patients with initially unresectable colorectal liver metastases

Lam, Vincent; Laurence, Jerome M.; Johnston, Emma; Hollands, Michael; Pleass, Henry; Richardson, A. J.

doi:10.1111/j.1477-2574.2012.00607.x

Cited by 180 publications

(136 citation statements)

References 58 publications

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“…To achieve total tumor clearance in metastatic CRC, all strategies to improve resectability, i.e. portal vein embolization with hepatic hypertrophy on the contralateral side or the ‘associating liver partition and portal vein ligation' technique, may be utilized as individually adjusted treatment concepts [47,48,49,50,51,52,53,54]. …”

Section: Treatment Strategies In Advanced Stages Of Colorectal Cancermentioning

confidence: 99%

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

et al. 2016

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Background: Although colorectal surgery is long established as the mainstay treatment for colon cancer, certain topics regarding technical fine-tuning to increase postsurgical recurrence-free survival have remained a matter of debate throughout the past years. These include complete mesocolic excision (CME), treatment strategies for metastatic disease, significance of hyperthermic intraperitoneal chemotherapy (HIPEC), and surgical techniques for the treatment of colorectal cancer recurrence. In addition, new surgical techniques have been introduced in oncologic colorectal surgery, and their potential to provide sufficiently radical resection has yet to be proven. Methods: A structured review of the literature was performed to identify the current state of the art with regard to the mentioned key issues in colorectal surgery. Results: This article provides a comprehensive review of the current literature addressing the above-mentioned current challenges in colorectal surgery. The focus lies on the impact of CME and, in relation to this, on lymph node dissection, as well as on treatment of metastatic disease including peritoneal spread, and finally on the treatment of recurrent disease. Conclusion: Uniformly, the current literature reveals that surgery aiming at complete malignancy elimination within multimodal treatment approaches represents the fundamental quantum leap for the achievement of long-term tumor-free survival.

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Section: Treatment Strategies In Advanced Stages Of Colorectal Cancermentioning

confidence: 99%

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

et al. 2016

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“…In addition, another 25-50% of patients develop subsequent metachronous metastases during the course of the disease (2,3). Surgical resection is currently considered the only potentially curative option for patients with metastatic CRC confined to the liver (4,5), and is associated with a 5-year overall survival (OS) rate of 37-58% (6).…”

mentioning

confidence: 99%

Maximum Diameter and Number of Tumors as a New Prognostic Indicator of Colorectal Liver Metastases

Yoshimoto

Morine

Imura

et al. 2017

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Abstract. Background: Surgical resection is currently considered the only potentially curative option as a treatment strategy of colorectal liver metastases (CRLM). Patients with MDN ≥30 had shown significantly poorer prognosis than patients with MDN <30 in OS and relapse-free survival (RFS). Conclusion: MDN ≥30 is an independent prognostic factor of survival in patients with CRLM and optimal surgical criterion of hepatectomy for CRLM.The liver is the most common site of metastasis in patients with colorectal cancer (CRC) (1), with 15-25% of patients presenting synchronous colorectal liver metastases (CRLM) (2). In addition, another 25-50% of patients develop subsequent metachronous metastases during the course of the disease (2, 3). Surgical resection is currently considered the only potentially curative option for patients with metastatic CRC confined to the liver (4, 5), and is associated with a 5-year overall survival (OS) rate of 37-58% (6). However, only 15-30% of patients with liver metastases may be initially resectable (7,8), but the criteria for selection of resectable CRLM remain unclear.According to Nordlinger et al., patients with CRLM have been classified into three clinical categories: (i) patients with resectable metastatic disease; (ii) patients with metastatic disease that is not optimally resectable (tumor size >5 cm, >4 metastases, synchronous CRLM, primary lymph node (LN)-positive, positive tumor markers and/or technically difficult) and (iii) patients unlikely to ever become resectable (9). Neoadjuvant chemotherapy was recommended for patients with resectable and unresectable CRLM, whereas first-line surgical resection was recommended only for patients with solitary metastases ≤2 cm and good prognostic features (10). In the European Society for Medical Oncology (ESMO) consensus guidelines for the management of patients with CRLM, patients were categorized by technical and oncological criteria. Oncological categories include (i) concomitant extrahepatic disease; (ii) number of lesions ≥5; (iii) tumor progression, with no mention of tumor size (11). However, clear criteria of surgical resection for CRLM have never been established.On the other hand, in hepatocellular carcinoma, the Milan criteria are used for a simple selection for liver transplantation around the world. The adaptation of liver transplantation was limited to one lesion smaller than 5 cm or up to 3 lesions smaller than 3 cm, and it is representing an approximate volume of tumor. In CRLM, simple criteria, using tumor number and size are required.Perioperative or neoadjuvant chemotherapy with various agents, alone or in combination, is the standard of care for most patients with CRLM (12, 13). Neoadjuvant chemotherapy in patients with initially unresectable CRLM can reduce metastasis sizes, converting initially unresectable to resectable lesions (conversion treatment) (9), making systemic chemotherapy in combination with liver resection an accepted 419

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“…However, the major reason for failure of the twostage hepatectomy was tumor progression while waiting for hypertrophy of the FLR or an insufficient increase in volume after portal vein occlusion (47,48). In a recent review analyzing short-and long-term outcomes of a large series of two-stage hepatectomies, morbidity was reported to range between 20 and 60% after the second surgery and the drop-out rate was reported to range between 8 and 31% (49).…”

Section: Associating Liver Partition and Pvl For Staged Hepatectomy (mentioning

confidence: 99%

Recent advances in surgical treatment of hepatocellular carcinoma

Song

2015

DD&T

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A systematic review of two‐stage hepatectomy in patients with initially unresectable colorectal liver metastases

Abstract: Two-stage hepatectomy is safe and effective in selected patients with initially unresectable CLM. Further studies are required to better define patient selection criteria for TSH and the exact roles of PVE and preoperative and interval chemotherapy.

Cited by 180 publications

References 58 publications

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

Maximum Diameter and Number of Tumors as a New Prognostic Indicator of Colorectal Liver Metastases

Recent advances in surgical treatment of hepatocellular carcinoma

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