Influence of two different resection techniques (conventional liver resection versus anterior approach) of liver metastases from colorectal cancer on hematogenous tumor cell dissemination – prospective randomized multicenter trial

Abstract

Background: Surgical hepatic resection remains the treatment of choice for patients with liver metastases from colorectal cancer despite the use of alternative therapeutic strategies. Although this procedure provides long-term survival in a significant number of patients, 50-75% of the patients develop intra-and/or extrahepatic recurrence. One possible reason for tumor recurrence may be intraoperative hematogenous tumor cell dissemination due to mechanical manipulation of the tumor during hepatic resection. Surgical technique may have an influence on hematogenous tumor cell spread. We hypothesize that hematogenous tumor cell dissemination may be reduced by using the anterior approach technique compared to conventional liver resection.

Liver resection for colorectal metastases: results and prognostic factors with 10-year follow-up

“…No patient with segment I location of CLM was alive 10 years after surgery; R1 surgical margin did not make a statistically significant difference in subgroup analysis. Liver mobilization to facilitate resection may increase the risk of tumor cell dissemination, possibly explaining these findings in our study and in other published studies [17]. A positive surgical margin was not a significant prognostic factor in our study.…”

“…The characteristics of the CLM are summarized in Table 2. The mean size of metastases was 6±4 cm [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], and the mean number was two. According to subgroup analysis, segment I location was not significantly associated with a positive surgical margin.…”

A Conceptual Technique for Laparoscopic Right Hepatectomy Based on Facts and Oncologic Principles

“…Indeed, several studies have reported that, during surgical manipulation of liver cancer, detachment and circulation of tumor cells led to an increased presence in the systemic circulation and were in turn associated with higher recurrence rates and poorer prognosis. [41][42][43] Altogether, we believe that this approach should be routinely undertaken in LRH.…”

Unique Localization of Circulating Tumor Cells in Patients With Hepatic Metastases

“…17 Increasingly, a variety of locoregional therapeutic modalities have been advocated to treat patients with unresectable liver metastases although intraoperative manipulation of organs has been reported to promote tumor spread. [18][19][20] Radiofrequency ablation (RFA), which converts radiofrequency waves into heat resulting in tissue desiccation and coagulative necrosis, has emerged over the last decade as an accepted method for treatment of liver metastases, although there have been no prospective randomized trials comparing RFA with other therapeutic modalities.…”