Recent advances in treatment for colorectal liver metastasis

Oki, Eiji; Ando, Koji; Nakanishi, Ryota; Shimada, Masahiko; Nakashima, Yasuhiro; Kubo, Nobuhide; Kudou, Kensuke; Saeki, Hiroshi; Nozoe, Tetsuo; Emi, Yasunori; Maehara, Yoshihiko

doi:10.1002/ags3.12071

Cited by 40 publications

(34 citation statements)

References 68 publications

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“…2,12 So, the utility of perioperative chemotherapy in patients with resectable CRLM is controversial and patient treatment varies substantially among institutions. 13 Turning to the details of the operation, R1 resection increases the risk of local recurrence and long-term survival. Previous studies showed advantage in OS 14,15 or DFS 16 with a negative margin of 1 cm or more over subcentimeter nega-tive margins; however, Pawlik et al reported using multicenter database that 557 patients were stratified with margin status into positive, negative 1 to 4 mm, 5 to 9 mm, and 1 cm or more.…”

Section: A Change In Surgical Indicationsmentioning

confidence: 99%

Evolution of Surgical Management of Colorectal Liver Metastasis

2020

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The treatment of colorectal liver metastasis (CRLM) has progressed markedly in the past decades. Main contributions stem from improvement in surgical approach and applications of chemotherapy. The availability of several perioperative and surgical techniques, including portal vein embolization, ablation techniques, and two-stage hepatectomies, has expanded surgical indications. In addition, preoperative imaging methods have contributed to these advances.In patients with high oncological risk of recurrence, or initially unresectable CRLM, highly individualized treatment regimens are becoming more widely utilized. These patients should be evaluated for surgical resection after several cycles of chemotherapy given the survival benefit afforded by liver resection for CRLM. Several biomarkers, including RAS mutation, BRAF mutation, and microsatellite stability, have become essential in guiding therapy. Immunotherapy has recently been highlighted, especially for cases of microsatellite instability. Looking forward, biomarkers will likely to continue to guide individualized treatment patterns.Liver transplantation as an option for patients with unresectable CRLM may boast comparable outcomes to patients with primary liver tumors, but it remains controversial considering the limited supply of donor livers.Management of CRLM requires the complex decision making process common to contemporary tumor board discussions, and a multidisciplinary approach likely figures into future directions of management for CRLM.

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Section: A Change In Surgical Indicationsmentioning

confidence: 99%

Evolution of Surgical Management of Colorectal Liver Metastasis

2020

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“…Hematogenous and lymphogenous metastasis-dominant CRC with highfrequency MSI (MSI-H) are reported to have poor prognosis. However, the validity as the prognostic factor of MMR is still to be confirmed, and it should thus be used cautiously [20,21].…”

Section: Prognostic Determinantsmentioning

confidence: 99%

“…On the other hand, it is also known that RAS and BRAF mutations are of prognostic and predictive value in mCRC [21]. The pathogenesis of CRC involves the accumulation of genetic and epigenetic modifications within pathways that regulate proliferation, apoptosis, and angiogenesis.…”

Section: Prognostic Determinantsmentioning

confidence: 99%

“…The authors concluded that multimodality therapy incorporating metastasectomy for BRAF V600E metastatic CRC should be considered and might be associated with improved OS in selected patients [24]. Meanwhile, BRAF V600E can be a biomarker for selecting the appropriate chemotherapy regimen [21].…”

Section: Prognostic Determinantsmentioning

confidence: 99%

“…Additionally, there may be comorbidities or liver dysfunction associated which grades the patient as ineligible for major surgery. In these cases, radiofrequency ablation (RFA) represents a great alternative [21].…”

Section: Radiofrequency Ablation Therapymentioning

confidence: 99%

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Colorectal Liver Metastases

Wiederkehr¹,

Wiederkehr²,

Wiederkehr³

2019

Surgical Challenges in the Management of Liver Disease

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The adenocarcinoma of the colon and rectum (CRC) affects more than 1.3 million patients each year, being the third most common malignancy in the world. Approximately, 30-50% of these patients will present with liver metastasis at the time of diagnosis or will develop metastasis later. The incidence of metastatic CRC (mCRC) is approximately 4.3% at 1 year, 8.7% at 2 years, 12% at 3 years, and 16.5% at 5 years after resection. Recently, the clinical outcome for patients with mCRC has improved, with a median overall survival (OS) for patients with mCRC is approximately 30 months, more than twice of that observed 20 years ago. The treatment approach for patients with colorectal liver metastases should be focused toward complete resection whenever possible, with both oncological and technical criteria being considered. Considering the fact that nearly 80% of patients with mCRC are not candidates for resection at diagnosis, initial treatment options include chemotherapy and locoregional therapies. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has emerged as modification on classic two-staged hepatectomy (TSH) with portal vein embolization. In experienced hepatobiliary centers and in well-selected patients, ALPPS can be performed with low morbidity and minimal mortality, resulting in good intermediate-term survival and excellent quality of life. Multidisciplinary tumor boards should critically scrutinize the best treatment options.

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

Noda

Takahashi

Tei

et al. 2022

Annals of Gastroent Surgery

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Aims Risk‐scoring systems for colorectal liver metastasis (CRLM) after hepatectomy allow prognoses to be predicted preoperatively. We investigated the clinical outcomes of neoadjuvant chemotherapy for resectable CRLM according to patient risk status, aiming to determine the subgroup of patients who could benefit from neoadjuvant chemotherapy. Methods In this multi‐institutional retrospective analysis, the preoperative risk score was calculated from six previously reported factors: synchronous metastases, primary lymph node positivity, tumor number, largest tumor diameter, extrahepatic metastasis, and the preoperative carbohydrate antigen 19–9 level. Patients were divided into three groups according to their risk scores: low risk (score = 0), intermediate risk (score 1–10), and high risk (score ≥11). Overall and recurrence‐free survival curves were calculated using the Kaplan–Meier method. After propensity‐score matching in the intermediate‐risk group, we compared clinicopathological features and outcomes. Results There were 318 cases, from 20 institutions. The preoperative risk score could be calculated in 277 cases. There were 34, 192, and 51 patients in the low‐, intermediate‐, and high‐risk groups, respectively. Intermediate‐risk group patients who received neoadjuvant chemotherapy had significantly better recurrence‐free survival than that of patients without neoadjuvant chemotherapy ( P = .0453). After propensity‐score matching in the intermediate‐risk group, the recurrence‐free survival rate was better in patients who received neoadjuvant chemotherapy ( P = .0261). But the overall survival rate was not improved after the matching. Conclusion Neoadjuvant chemotherapy for resectable CRLM might prolong the recurrence‐free survival period for intermediate‐risk patients with preoperative risk scores in the range of 1–10, but the overall survival was not improved by neoadjuvant chemotherapy.

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Recent advances in treatment for colorectal liver metastasis

Cited by 40 publications

References 68 publications

Evolution of Surgical Management of Colorectal Liver Metastasis

Evolution of Surgical Management of Colorectal Liver Metastasis

Colorectal Liver Metastases

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

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