High Survival Rate After Two-Stage Resection of Advanced Colorectal Liver Metastases: Response-Based Selection and Complete Resection Define Outcome

Brouquet, Antoine; Abdalla, Eddie K.; Kopetz, Scott; Garrett, Christopher R.; Overman, Michael J.; Eng, Cathy; Ανδρέου, Ανδρέας; Loyer, Evelyne M.; Madoff, David C.; Curley, Steven A.; Vauthey, Jean Nicolas

doi:10.1200/jco.2010.32.6132

Cited by 358 publications

(305 citation statements)

References 28 publications

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“…Resection of the primary can be combined with the left hemiliver clearance during the first stage because the hepatectomy is usually limited to fewer than three segments. The two-stage approach has been shown to be associated with a better survival outcome than with chemotherapy without surgery in patients with liver-only disease and an objective response to chemotherapy: the 5-year OS rates were 51% versus 15%, respectively (p ϭ .005) [102]. The surgical mortality rate is significantly higher when surgery of extensive hepatic resections is combined with colorectal resection [87,103].…”

Section: Initially Unresectable Patientsmentioning

confidence: 94%

“…However, surgical resection margins are currently selected using preoperative radiology, IOUS, and palpation, none of which take into account the possibility of a halo, increasing the risk for disease recurrence [122]. The use of two-stage hepatectomies may help to reduce the risk for recurrence by allowing pathological assessment between resections [102]. Lesions that have disappeared on imaging after chemotherapy have been found to contain viable tumor cells when resected [73].…”

Section: Pathological Responsementioning

confidence: 99%

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The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

et al. 2012

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ABSTRACTpatients receive in different centers. Based on current evidence, the group agreed on a number of issues including the following: (a) the primary aim of treatment is achieving a long disease-free survival (DFS) interval following resection; (b) assessment of resectability should be performed with high-quality cross-sectional imaging, staging the liver with magnetic resonance imaging and/or abdominal computed tomography (CT), depending on local expertise, staging extrahepatic disease with thoracic and pelvic CT, and, in selected cases, fluorodeoxyglucose positron emission tomography with ultrasound (preferably contrastenhanced ultrasound) for intraoperative staging; (c) optimal first-line chemotherapy-doublet or triplet chemotherapy regimens combined with targeted therapy-is advisable in potentially resectable patients; (d) in this situation, at least four courses of first-line chemotherapy should be given, with assessment of tumor response every 2 months; (e) response assessed by the Response Evaluation Criteria in Solid Tumors (conventional chemotherapy) or nonsize-based morphological changes (antiangiogenic agents) is clearly correlated with outcome; no imaging technique is currently able to accurately diagnose complete pathological response but high-quality imaging is crucial for patient management; (f) the duration of chemotherapy should be as short as possible and resection achieved as soon as technically possible in the absence of tumor progression; (g) the number of metastases or patient age should not be an absolute contraindication to surgery combined with chemotherapy; (h) for synchronous metastases, it is not advisable to undertake major hepatic surgery during surgery for removal of the primary CRC; the reverse surgical approach (liver first) produces as good an outcome as the conventional approach in selected cases; (i) for patients with resectable liver metastases from CRC, perioperative chemotherapy may be associated with a modestly better DFS outcome; and (j) whether initially resectable or unresectable, cure or at least a long survival duration is possible after complete resection of the metastases, and MDT treatment is essential for improving clinical and survival outcomes. The group proposed a new system to classify initial unresectability based on technical and oncological contraindications.

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Section: Initially Unresectable Patientsmentioning

confidence: 94%

Section: Pathological Responsementioning

confidence: 99%

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

et al. 2012

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“…With modern oncosurgical approaches, patients with resected liver metastases can experience up to 50-60% 5-year overall survival and a median survival of 46-64 months. [6][7][8] Systemic chemotherapy may achieve this goal in 10-20% of initially unresectable patients. 9,10 The high rate of inoperable patients and intrahepatic recurrence rates are another relevant problem.…”

mentioning

confidence: 99%

Transarterial chemoembolization of unresectable systemic chemotherapy‐refractory liver metastases from colorectal cancer: Long‐term results over a 10‐year period

Gruber‐Rouh

Naguib

Eichler

et al. 2013

Intl Journal of Cancer

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The aims of the study were to evaluate therapeutic efficacy and to determine the prognostic factors for treatment success in patients with liver metastases from colorectal cancer (CRC) treated with transarterial chemoembolization (TACE). A total of 564 patients (mean age, 60.3 years) with liver metastases of CRC were repeatedly treated with TACE. In total, 3,384 TACE procedures were performed (mean, six sessions per patient). The local chemotherapy protocol consisted of mitomycin C alone (43.1%), mitomycin C with gemcitabine (27.1%), mitomycin C with irinotecan (15.6%) or mitomycin C with irinotecan and cisplatin (15.6%). Embolization was performed with lipiodol and starch microspheres. Tumor response was evaluated using magnetic resonance imaging or computed tomography. The change in tumor size was calculated and the response was evaluated according to the RECIST-Criteria. Survival rates were calculated according to the Kaplan-Meier method. Prognostic factors for patient's survival were evaluated using log-rank test. Evaluation of local tumor control showed partial response in 16.7%, stable disease in 48.2% and progressive disease in 16.7%. The 1-year survival rate after chemoembolization was 62%, the 2-year survival rate was 28% and the 3-year survival rate was 7%. Median survival from the start of chemoembolization treatment was 14.3 months. The indication (p 5 0.001) and initial tumor response (p 5 0.015) were statistically significant factors for patient's survival. TACE is a minimally invasive therapy option for controlling local metastases and improving survival time in patients with hepatic metastases from CRC. TN stage, extrahepatic metastases, number of lesions, tumor location within the liver and choice of chemotherapy protocol of TACE are none significant factors for patient's survival.The development of liver metastases in patients with colorectal cancer (CRC) substantially affects the prognosis of the patient. At the time of first diagnosis of CRC, 20-50% of all patients already present with synchronous liver metastases. Liver metastases develop in about 60-70% of CRC patients during the course of their disease and are the most common cause of death of patients with CRC. [1][2][3] Resection is the only potentially curative therapy for patients with liver metastases from CRC. 4,5 Only 20% of patients with liver metastases will be candidates for resection. With modern oncosurgical approaches, patients with resected liver metastases can experience up to 50-60% 5-year overall survival and a median survival of 46-64 months.6-8 Systemic chemotherapy may achieve this goal in 10-20% of initially unresectable patients. 9,10 The high rate of inoperable patients and intrahepatic recurrence rates are another relevant problem. Currently, the standard first-line treatment of metastatic CRC is a combination of infusional 5-FU, folinic acid with either irinotecan (FOLFIRI) or oxaliplatin (FOLFOX). The response rate to these schedules is 50%, and 50% of patients will progress within 10 months. In second-line therap...

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“…, two sequentia mic resections a o 6 weeks and mass in the con val, although a ase in the mean and the secon olized hemi-liv and alcoholizat 51% [168,169] . P…”

Section: Portal Vein Occlusionmentioning

confidence: 99%

Metastatic lesions to the liver: Surgical indications and techniques

Tejedor¹,

Serrablo²

2013

JST

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Background: Although there is an established agreement on the advantage of liver resection for metastatic colorectal and neuroendocrine tumours, the role of hepatic surgery in patients with liver metastases from non-colorectal and non-neuroendocrine carcinoma is not well defined. In recent years, despite the poor results, liver metastases suitable for surgery have been treated with resection. The results reported in recent studies support a developing trend toward surgery in this setting. Also, as there are no data that in fact suggest the utility of alternative treatments for these lesions, the role of surgery is reinforced. Methods:A systematic search of English and non-English literature using MEDLINE on the outcomes of patients after surgical treatment of liver metastases from different solid tumours was undertaken. A summary of current surgical techniques used to improve their resectability has been added.Results: All papers reporting median survival and 5-year survival have been selected and presented in tables for most of the primary tumours reviewed. Conclusions:Apart from patients with colorectal and neuroendocrine tumours, liver resection may offer a significative survival advantage in selected patients, mainly those with metastases coming from breast, gastrointestinal stromal tumours, testis, ovary and kidney.

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High Survival Rate After Two-Stage Resection of Advanced Colorectal Liver Metastases: Response-Based Selection and Complete Resection Define Outcome

Cited by 358 publications

References 28 publications

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

Transarterial chemoembolization of unresectable systemic chemotherapy‐refractory liver metastases from colorectal cancer: Long‐term results over a 10‐year period

Metastatic lesions to the liver: Surgical indications and techniques

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