Indications for conversion hepatectomy for initially unresectable colorectal cancer with liver metastasis

Abstract

Purpose Selected patients with initially unresectable colorectal cancer (CRC) and liver metastases undergo conversion surgery after appropriate chemotherapy. The prognosis of these patients is good, with some even cured of the disease. This retrospective, single-institution study analyzes the clinical importance of patient characteristics on the outcomes of conversion hepatectomy. Methods We evaluated 229 consecutive patients with initially unresectable CRC and liver metastasis, who underwent systemic chemotherapy. The patients were assigned to groups depending on conversion hepatectomy. Results Conversion hepatectomy was performed in 30 patients (13.1%). The proportion of patients with extrahepatic metastasis was significantly lower in the conversion group than in the unresectable group (30.0 vs. 66.8%; P < 0.01). The rate of left-sided primary colorectal tumors was significantly higher in the conversion group than in the unresectable group (96.7 vs. 65.8%; P < 0.01). Multivariate analyses identified that left-sided tumors, no extrahepatic metastasis, H1 or H2 grade CLM, and treatment with molecular-targeted agents were associated with conversion hepatectomy (odds ratios: 16.314, 4.216, 7.631, and 4.070; P < 0.01). Overall survival was significantly longer in the conversion group than in the unresectable group (MST: 50.0 versus 14.7 months; P < 0.01). Conclusion Left-sided primary tumors, absence of extrahepatic metastases, H1 or H2 grade, and use of molecular-targeted agents were associated with successful conversion hepatectomy; thus, patients with these characteristics may be candidates for conversion therapy.

Clinical outcomes of neoadjuvant chemotherapy for resectable colorectal liver metastasis with intermediate risk of postoperative recurrence: A multi‐institutional retrospective study

“…Some patients with unresectable diseases could show an excellent response and receive the conversion surgery. 28 , 29 These curative treatments for recurrent lesions or surgical treatment for other recurrent lesions, such pulmonary metastasis or lymph node metastasis, might have contributed to the overall survival. In this study, the date for the treatments administered for the recurrent lesions were not obtained.…”

Simple systemic index associated with oxaliplatin‐induced liver damage can be a novel biomarker to predict prognosis after resection of colorectal liver metastasis

“…These patients were treated with chemotherapy, and the decision of the chemotherapy regimen was made mainly by the oncologist according to the patient's condition. 5 We evaluated the clinicopathological factors and overall survival (OS) to specifically determine the association of liver sinusoidal disorders and liver function with the prognosis in patients who underwent hepatectomy for CRLM.…”

“…These patients were treated with chemotherapy, and the decision of the chemotherapy regimen was made mainly by the oncologist according to the patient's condition. 5 …”

“…The criteria for clearly unresectable, not optimally resectable, and not suitable for curative resection were as follows: (i) synchronous metastases in multiple organs; (ii) expectation of insufficient residual liver volume or function after liver resection; (iii) CRLM invasion of critical structures of the liver, such as the hilum and root of the hepatic vein, making their resection difficult without leaving residual metastasis; and (iv) Japanese Classification of Colorectal Category H2 or H3 (more than five liver metastatic lesions and/or a maximum diameter larger than 5 cm), which is associated with a poorer prognosis for patients undergoing liver resection than for those in Category H1. These patients were treated with chemotherapy, and the decision of the chemotherapy regimen was made mainly by the oncologist according to the patient's condition 5 …”

“…Additionally, complete resection of both the primary tumor and CRLM improves the survival expectancy compared with systemic therapies 4 . To increase the chance of long‐term survival even in patients with unresectable liver metastasis, radical resection is selected as conversion therapy when the tumor shrinks or becomes resectable by chemotherapy 5 . In past reports, oxaliplatin‐based fluorouracil + folinic acid + oxaliplatin (FOLFOX) therapy was often the first choice because FOLFOX therapy has a higher hepatectomy rate than irinotecan‐based FOLFIRI therapy 6 …”