Combined colon and hepatic resection for synchronous colorectal liver metastases

Lyass, Sergey; Zamir, Gideon; Matot, Idit; Goitein, David; Eid, Ahmed; Jurim, Oded

doi:10.1002/jso.1117

Cited by 117 publications

(79 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Liver metastases are one of the principal causes of death in these patients. About 25% of patients have liver metastases at the time of presentation and another 20% subsequently develop liver metastases (Norum et al, 1997;Lyass et al, 2001). Median survival of untreated colorectal liver metastases is approximately 9 months with few survivors beyond 2 years (Bengtsson et al, 1981;Fujimoto et al, 1985;Giacchi et al, 1988;Daly et al, 1989).…”

mentioning

confidence: 99%

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

2006

View full text Add to dashboard Cite

The aim of the study was to prospectively evaluate an intensive follow-up programme using serial tumour marker estimations and contrast-enhanced computed tomography (CT) of the chest and abdomen in patients undergoing potentially curative resection of colorectal liver metastases. Seventy-six consecutive patients having undergone potentially curative resections of colorectal liver metastases in a single unit were followed up with a protocol of 3 monthly carcinoembryonic antigen and carbohydrate antigen 19-9 estimations and contrast-enhanced spiral CT of the chest, abdomen and pelvis for the first 2 years following surgery and 6 monthly thereafter. The median period of follow-up was 24 months (range 18 -60). Recurrent tumour was classed as early if within 6 months of liver resection. Thirty-seven of the 76 patients (49%) developed recurrence on follow-up. Nineteen recurrences were in the liver alone (51%), 16 liver and extrahepatic (43%) and two extrahepatic alone (6%). Of the 19 patients with isolated liver recurrence, eight developed within 6 months of liver resection none of which were resectable. Of the 11 recurrences after 6 months, five (45%) were resectable. Of the 37 recurrences, CT indicated recurrence despite normal tumour markers in 19 patients. Tumour markers suggested recurrence before imaging in 12 and concurrently with imaging in 6. In the 12 patients who presented with elevated tumour markers before imaging, there was a median lag period of 3 months (range 1 -21) in recurrence being detected on further serial imaging. Seventeen patients who developed recurrence had normal tumour markers before initial resection of their liver metastases. Of these 17, 10 (58%) had an elevation of tumour markers associated with recurrence. Over a median follow-up of 2 years following liver resection, the use of CT or tumour markers alone would have failed to demonstrate early recurrence in 12 and 18 patients respectively. A combination of tumour markers and CT detected significantly more (Po0.05) recurrence than either modality alone. Tumour markers and CT should be used in combination in the follow-up of patients with resected colorectal liver metatases, including patients whose markers are normal at the time of initial liver resection.

show abstract

mentioning

confidence: 99%

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

2006

View full text Add to dashboard Cite

show abstract

“…5,6,8,12,20,21,25,26,28 In these series, 5year OS for simultaneous resections ranged from 29% to 55%; our results suggest that com parable outcomes are achieved in routine practice. We report outcomes of patients who underwent staged resections for illustrative purposes only.…”

Section: Discussionmentioning

confidence: 52%

“…11,18,19 However, these reports are based on procedures performed in the 1990s, when liver resections were not as safe as they are now. In fact, more recent studies consistently report comparable mortality between simultaneous and staged resec tions [7][8][9]12,[20][21][22][23][24] ranging from 0% to 3.5%. In the present study, 30 and 90day mortality from simultaneous resection was < 2% and < 5%, respectively, which is sim ilar to that reported in most contemporary series.…”

Section: Discussionmentioning

confidence: 92%

“…More recently, with improvements in perioperative care and anesthesia as well as advances in imaging and liver surgery, this approach has been challenged with several studies dem onstrating comparable safety and outcome with a simultaneous surgical strategy. [5][6][7][8][9][10][11][12] Combing both resec tion of the primary malignancy and the hepatic metas tases avoids the morbidity of a second major operation, theoretically lowers the risk of disease dissemination and allows for timely completion of adjuvant therapies. Although a simultaneous approach appears feasible, the literature supporting this strategy is derived largely from highvolume single centres and multiinstitutional case series.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Simultaneous resection of primary colorectal cancer and synchronous liver metastases: a population-based study

Nanji

Mackillop

Wei

et al. 2017

CJS

View full text Add to dashboard Cite

Background: Simultaneous resection of primary colorectal cancer (CRC) and syn chron ous liver metastases (LM) is gaining interest. We describe management and out comes of patients undergoing simultaneous resection in the general population. Methods: All patients with CRC who underwent surgical resection of LM between 2002 and 2009 were identified using the populationbased Ontario Cancer Registry and linked electronic treatment records. Synchronous disease was defined as having resection of CRCLM within 12 weeks of surgery for the primary tumour. Results: During the study period, 1310 patients underwent resection of CRCLM. Of these, 226 (17%) patients had synchronous disease; 100 (44%) had a simultaneous resection and 126 (56%) had a staged resection. For the simultaneous and the staged groups, the mean number of liver lesions resected was 1.6 and 2.3, respectively (p < 0.001); the mean size of the largest lesion was 3.1 and 4.8 cm, respectively (p < 0.001); and the major hepatic resection rate was 21% and 79%, respectively (p < 0.001). Post operative mortality for simultaneous cases at 90 days was less than 5%. Fiveyear overall survival and cancerspecific survival for patients with simultaneous resection was 36% (95% confidence interval [CI] 26%-45%) and 37% (95% CI 25%-50%), respectively. Simultaneous resections are common in the general population. A more conservative approach is being adopted for simultaneous resections by limiting the extent of liver resection. Postoperative mortality and longterm survival in this patient population is similar to that reported in other contemporary series. Conclusion: Compared with a staged approach, patients undergoing simultaneous resections had fewer and smaller liver metastases and underwent less aggressive resec tions. Onethird of these patients achieved longterm survival.

show abstract

“…In the case of an obstructing primary tumor or a patient with significant anemia, a surgical approach to address the primary tumour is usually required prior to consideration of chemotherapy and/or resection of CRLM. In asymptomatic patients, staged or combined resections of the primary and metastatic lesions can be considered, with similar perioperative outcomes and survival in large retrospective series (de Haas et al, 2010;Lyass et al, 2001;Martin et al, 2009). One clinical trial is currently accruing patients in an attempt to address this question prospectively (Rennes University Hospital, 2009).…”

mentioning

confidence: 99%

Neoadjuvant Chemotherapy for Colorectal Liver Metastases

Hebbard¹,

McConnell²,

Bathe³

2012

Neoadjuvant Chemotherapy - Current Applications in Clinical Practice

View full text Add to dashboard Cite

Combined colon and hepatic resection for synchronous colorectal liver metastases

Cited by 117 publications

References 11 publications

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

Simultaneous resection of primary colorectal cancer and synchronous liver metastases: a population-based study

Neoadjuvant Chemotherapy for Colorectal Liver Metastases

Contact Info

Product

Resources

About