Management of disappearing colorectal liver metastases: an international survey

Melstrom, Laleh G.; Warner, Susanne G.; Wong, Paul; Sun, Virginia; Raoof, Mustafa; Singh, Gagandeep; Chavin, Kenneth D.; Fong, Yuman; Adam, René; Hugh, Thomas J.

doi:10.1016/j.hpb.2020.10.005

Cited by 13 publications

(8 citation statements)

References 32 publications

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“…In the last decades, advances in the systemic therapy, could potentially turn into resectable candidates patients with previously unresectable disease. 4 Vanishing CRLM are defined as lesions identified prechemotherapy and subsequently not visible on CT. 5 In addition, neoadjuvant systemic therapy increased steatosis and steatohepatitis of liver parenchyma limiting their detectability. The management of these lesions remain controversial when surgical treatment is elected.…”

Section: Discussionmentioning

confidence: 99%

“…The management of these lesions remain controversial when surgical treatment is elected. 4 Marking CRLM should be considered in some situations; In patients with CRLM at risk of becoming missing after systemic neoadjuvant or ablative treatment and in lesions which characteristics make their intraoperative ultrasound detectability difficult such as small intraparenchymal lesions, hypoechogenic lesions or mild/ severe liver steatosis. 6,7 Casado et al 7 used percutaneous placement of marking coils CT guided before neoadjuvant therapy in the deep margin of a CRLM located in the intersection of segments V-VI-VII-VIII.…”

Section: Discussionmentioning

confidence: 99%

“…In the last decades, advances in the systemic therapy, could potentially turn into resectable candidates patients with previously unresectable disease. 4…”

Section: Discussionmentioning

confidence: 99%

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Onyx®, A New Tool for Intraoperative Localization of Liver Lesions

Rubio-García,

Mantilla Pinilla,

Gil Sánchez

et al. 2024

Surg Innov

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Background Precise preoperative localization of liver tumors facilitates successful surgical procedures, Intraoperative ultrasonography is a sensitive imaging modality. However, the presence of small non-palpable isoechoic intraparenchymal lesions may be challenging intraoperatively. Methodology and Material Description Onyx® is a non-adhesive liquid agent comprised of ethylene-vinyl alcohol usually used dissolved in dimethyl-sulfoxide and suspended micronized tantalum powder to provide contrast for visualization under fluoroscopy and ultrasonography and a macroscopic black shape. This embolization material has been increasingly used for the embolization of intracranial arteriovenous malformations. We present the novel application of Onyx® on liver surgery. Current Status We present the case of a female, 55 years-old, whose medical history revealed an elective sigmoidectomy (pT3N1a). After 17 months of follow up, by PET-CT scan, the patient was diagnosed of a small intraparenchymal hypo-attenuated 13 mm tumor located at segment V consistent with metachronous colorectal liver metastasis. Open metastasectomy was performed, ultrasonography-guided Onyx® infusion was delivered the day after, intraoperative ultrasonography showed a palpable hyperechoic material with a posterior acoustic shadowing artifact around the lesion. Onyx® is a promising new tool, without any previous application on liver surgery, feasible with advantages in small not palpable intraparenchymal liver lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Onyx®, A New Tool for Intraoperative Localization of Liver Lesions

Rubio-García,

Mantilla Pinilla,

Gil Sánchez

et al. 2024

Surg Innov

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“…Thus, in initially unresectable disease, a longer duration of PO-SACT could be assumed as a surrogate of insufficient down-sizing capability due to an extensive tumor load or to a chemoresistant biological tumoral phenotype. Additionally, prolonged pre-operative treatment could increase the risk of disappearing metastases, which might not have been completely sterilized by the PO-SACT [ 28 , 29 ]. Thus, our findings support performing liver surgery as soon as technically feasible after active PO-SACT; this approach of early resection could also reduce the risks of chemotherapy-induced hepatotoxicity [ 30 , 31 ], therefore decreasing postoperative complication risks; this aspect could be particularly beneficial for elderly patients, altogether at higher risk of postoperative mortality after liver resection [ 32 ]; moreover, shorter chemotherapy exposure would also arguably reduce the incidence of other cumulative toxicities, thus allowing potential re-challenge with active anticancer medications, postoperatively or in case of relapse.…”

Section: Discussionmentioning

confidence: 99%

Impact of Preoperative Chemotherapy Features on Patient Outcomes after Hepatectomy for Initially Unresectable Colorectal Cancer Liver Metastases: A LiverMetSurvey Analysis

Innominato

Cailliez

Allard

et al. 2022

Cancers

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Background: Prognostic factors have been extensively reported after resection of colorectal liver metastases (CLM); however, specific analyses of the impact of preoperative systemic anticancer therapy (PO-SACT) features on outcomes is lacking. Methods: For this real-world evidence study, we used prospectively collected data within the international surgical LiverMetSurvey database from all patients with initially-irresectable CLM. The main outcome was Overall Survival (OS) after surgery. Disease-free (DFS) and hepatic-specific relapse-free survival (HS-RFS) were secondary outcomes. PO-SACT features included duration (cumulative number of cycles), choice of the cytotoxic backbone (oxaliplatin- or irinotecan-based), fluoropyrimidine (infusional or oral) and addition or not of targeted monoclonal antibodies (anti-EGFR or anti-VEGF). Results: A total of 2793 patients in the database had received PO-SACT for initially irresectable diseases. Short (<7 or <13 cycles in 1st or 2nd line) PO-SACT duration was independently associated with longer OS (HR: 0.85 p = 0.046), DFS (HR: 0.81; p = 0.016) and HS-RFS (HR: 0.80; p = 0.05). All other PO-SACT features yielded basically comparable results. Conclusions: In this international cohort, provided that PO-SACT allowed conversion to resectability in initially irresectable CLM, surgery performed as soon as technically feasible resulted in the best outcomes. When resection was achieved, our findings indicate that the choice of PO-SACT regimen had a marginal if any, impact on outcomes.

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“…These findings point to an important treatment paradigm adopted by surgeons in which lesions not readily identified by both preoperative and intraoperative imaging are less likely to harbor residual disease [ 118 ]. In an international survey with 226 respondents, Melstrom et al, found that 63% of surgeons would wait a specific period of time off of chemotherapy in the setting of DLMs to assess the durability of response prior to proceeding with resection.…”

Section: Perioperative Considerationsmentioning

confidence: 99%

Contemporary Surgical Management of Colorectal Liver Metastases

Chandra,

Sacks

2024

Cancers

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Colorectal cancer is the third most common cancer in the United States and the second most common cause of cancer-related death. Approximately 20–30% of patients will develop hepatic metastasis in the form of synchronous or metachronous disease. The treatment of colorectal liver metastasis (CRLM) has evolved into a multidisciplinary approach, with chemotherapy and a variety of locoregional treatments, such as ablation and portal vein embolization, playing a crucial role. However, resection remains a core tenet of management, serving as the gold standard for a curative-intent therapy. As such, the input of a dedicated hepatobiliary surgeon is paramount for appropriate patient selection and choice of surgical approach, as significant advances in the field have made management decisions extremely nuanced and complex. We herein aim to review the contemporary surgical management of colorectal liver metastasis with respect to both perioperative and operative considerations.

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Management of disappearing colorectal liver metastases: an international survey

Cited by 13 publications

References 32 publications

Onyx®, A New Tool for Intraoperative Localization of Liver Lesions

Onyx®, A New Tool for Intraoperative Localization of Liver Lesions

Impact of Preoperative Chemotherapy Features on Patient Outcomes after Hepatectomy for Initially Unresectable Colorectal Cancer Liver Metastases: A LiverMetSurvey Analysis

Contemporary Surgical Management of Colorectal Liver Metastases

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