Aggressive Treatment of Patients with Metastatic Colorectal Cancer Increases Survival: A Scandinavian Single-Center Experience

Abstract

Background. We examined overall and disease-free survivals in a cohort of patients subjected to resection of liver metastasis from colorectal cancer (CRLM) in a 10-year period when new treatment strategies were implemented. Methods. Data from 239 consecutive patients selected for liver resection of CRLM during the period from 2002 to 2011 at a single center were used to estimate overall and disease-free survival. The results were assessed against new treatment strategies and established risk factors. Results. The 5-year cumulative overall and disease-free survivals were 46 and 24%. The overall survival was the same after reresection, independently of the number of prior resections and irrespectively of the location of the recurrent disease. The time intervals between each recurrence were similar (11 ± 1 months). Patients with high tumor load given neoadjuvant chemotherapy had comparable survival to those with less extensive disease without neoadjuvant chemotherapy. Positive resection margin or resectable extrahepatic disease did not affect overall survival. Conclusion. Our data support that one still, and perhaps to an even greater extent, should seek an aggressive therapeutic strategy to achieve resectable status for recurrent hepatic and extrahepatic metastases. The data should be viewed in the context of recent advances in the understanding of cancer biology and the metastatic process.

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

“…Patients were scheduled for liver surgery after completion of preoperative radiotherapy to the rectal primary and it was performed as open or laparoscopic and as a one-or two-stage procedure [11]. Resection of the rectal primary was performed at least 6 weeks after completion of adjuvant treatment.…”

Heterogeneous radiological response to neoadjuvant therapy is associated with poor prognosis after resection of colorectal liver metastases

“…With the increased use of new oncological, surgical and ablative treatments, the indications for surgery have expanded, and about 25% of CRLM patients are offered liver resection today. A five-year overall survival of about 50% is typical in non-selected series [2], with early relapse and death after surgery in about one third of the patients. At present there is no reliable way to identify these patients, and precise markers for patient stratification and treatment selection are highly warranted.…”

Radiofrequency ablation of unresectable colorectal liver metastases: trends in management and outcome during a decade at a single center

“…Perioperative chemotherapy and multimodal approaches such as portal vein embolization, two-stage hepatectomy, vascular reconstructions, and autotransplantation have increased the proportion of patients with resectable CRLM ( 4 , 7 – 9 ). These new treatment strategies were introduced in our center during the study period ( 23 ). Although the yearly number of patients with CRLM undergoing resection increased significantly from 2001 to 2011, the yearly number of patients undergoing RFA in our center has not increased throughout the period ( 23 ).…”

“…In period I, neoadjuvant chemotherapy was primarily given to non-resectable patients in our institution, with the aim of converting the disease to become resectable. In period II, the indications for perioperative chemotherapy evolved, and perioperative chemotherapy was more likely given to resectable patients with high tumor load (≥3 metastases or >3.0 cm in diameter) or patients with primary tumor and synchronous metastases ( 22 , 23 ). Later, CEA level and performance status became part of the consideration.…”