Impact of portal vein embolization on long-term survival of patients with primarily unresectable colorectal liver metastases

Wicherts, Dennis A.; Haas, Robbert J. de; Andreani, P.; Sotirov, D; Salloum, Chady; Castaing, Denis; Adam, René; Azoulay, Daniel

doi:10.1002/bjs.6756

Cited by 113 publications

(93 citation statements)

References 36 publications

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“…Nowadays, multiple liver metastases are less often considered a contraindication because of the emergence of effective neo-adjuvant systemic therapy [16] and improvements in surgical strategies. With combinations of portal vein embolization [29], RFA therapies [30] or 2-staged resections [19,31] more patients become eligible for liver resection.…”

Section: Discussionmentioning

confidence: 99%

Liver Resection for Metastatic Disease; A Population-Based Analysis of Trends

Ridder

Lemmens²,

Overbeek³

et al. 2016

Dig Surg

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Objective: The study aims to evaluate all patients who underwent liver resection for metastatic disease for demographics, characteristics of the primary tumor and metastasis, volume of liver resection specimens per pathology laboratory and to describe trends in surgical treatment. Methods: Data were prospectively collected using the Dutch nationwide pathology network. All pathology reports containing details on liver resections for metastatic disease between January 2001 and December 2010 were evaluated. Results: A total of 3,916 liver resections were performed in 3,699 patients with a median age of 63 years (range 1-91). The primary tumor was mainly colorectal (n = 3,256; 88.0%). The number of ‘high volume liver centers' increased from 2 to 12 in the study period, whereas the number of ‘low volume centers' decreased. The number of liver resections increased from 224 to 596 per year (p ≤ 0.0001). A significant increase was demonstrated in elderly patients, patients with multiple metastases, liver resections for smaller metastases and minor liver resections. Conclusion: Although the majority of patients were young and had solitary metastasis, indications for liver resection are expanding as indicated by increasing numbers of elderly and patients with multiple liver metastases. Patients with non-colorectal liver metastases were seldom candidates for resection.

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Section: Discussionmentioning

confidence: 99%

Liver Resection for Metastatic Disease; A Population-Based Analysis of Trends

Ridder

Lemmens²,

Overbeek³

et al. 2016

Dig Surg

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“…A range of strategies has now been developed to render a patient's disease surgically resectable (e.g., portal vein embolization, neoadjuvant chemotherapy, hepatectomy combined with radiofrequency ablation, two-stage hepatectomy) [82,83]. Portal vein embolization is indicated when the FLR as a proportion of total liver volume is 20%-30% in patients with a normal liver and Յ40% in patients who have had extensive chemotherapy [17,84]. The efficacy of conversion chemotherapy has increased dramatically in recent years, and it has become the best means of downsizing tumoral disease and converting patients with unresectable disease to resectability [30].…”

Section: Initially Unresectable Patientsmentioning

confidence: 99%

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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“…8,9 ). The long-term results of liver resections after the PVE are practically comparable with the primary surgeries 10 . With regard to asymptomatic survival, then, in general, poorer outcomes are achieved after liver resections after the PVE compared to the primary resections without the PVE (ref.…”

Section: Discussionmentioning

confidence: 64%

A complex oncosurgical approach to increasing the resectability of colorectal cancer metastases - a case report

Třeška¹,

Šafránek²,

Lysák³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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, Ondrej Hes dAim. In this case report, the authors aim to demonstrate the success of recent methods in the radical treatment of a patient with primary inoperable liver and subsequent colorectal cancer pulmonary metastases. Methods. A 75 year old patient with inoperable bulky metastasis in the right hepatic lobe and insufficient future remnant liver volume was indicated for a stage procedure in the liver parenchyma. Embolization of the right branch of the portal vein was first performed with subsequent administration of stem cells into the contralateral liver lobe. Following compensatory growth of the left liver lobe, right-sided hepatectomy was performed with subsequent adjuvant oncological treatment. Six months after the surgery, a metastasis developed in the right pulmonary lobe which was solved by metastasectomy. Results. The patient, one year after the diagnosis of inoperable liver metastasis, is completely healthy and free of signs of disease recurrence. Conclusion. A comprehensive oncosurgical approach using up-to-date diagnostic and treatment options may offer patients with metastatic colorectal cancer, radical treatment with the hope of long-term quality survival.

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Impact of portal vein embolization on long-term survival of patients with primarily unresectable colorectal liver metastases

Abstract: : PVE increased the resectability rate of initially unresectable CLM. Among patients who had PVE, long-term survival was better in those who had resection than in those who did not. PVE is of importance in the multimodal treatment of advanced CLM.

Cited by 113 publications

References 36 publications

Liver Resection for Metastatic Disease; A Population-Based Analysis of Trends

Liver Resection for Metastatic Disease; A Population-Based Analysis of Trends

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

A complex oncosurgical approach to increasing the resectability of colorectal cancer metastases - a case report

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