Resection of Colorectal Liver Metastases: Current Perspectives

McLoughlin, James M.; Jensen, Eric H.; Malafa, Mokenge P.

doi:10.1177/107327480601300105

Cited by 74 publications

(37 citation statements)

References 114 publications

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“…The main cause of death in patients with colorectal cancer is metastatic disease (2,3). Most often, CRC metastases arise in the liver (66%) (4), with the following locations in the order of frequency being peritoneal (15%), pulmonary (10%) and bone (1.9%) (5).…”

Section: Introductionmentioning

confidence: 99%

Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Diaconescu¹,

Alexandrescu²,

Ionel³

et al. 2017

chr

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Introducere: Beneficiul rezecţiei hepatice în cazul metastazelor hepatice şi extrahepatice colorectale (MHEHCR) este încă discutabil. Scopul acestui studiu este de a evalua rezultatele rezecţiei metastazelor hepatice şi extrahepatice efectuate pacienţilor cu MHEHCR într-un centru medical cu un volum mare de intervenţii chirurgicale, atât în sfera chirurgiei hepato-biliare, cât şi în sfera chirurgiei colo-rectale şi de a identifica factorii de prognostic care se corelează cu o supravieţuire îndelungată. Metoda: Studiul este unul retrospectiv şi se bazează pe un lot de 678 de pacienţi consecutivi, cu metastaze hepatice ale cancerului colo-rectal operate într-un singur centru chirurgical, în perioada aprilie 1996 -martie 2016. Dintre aceştia, 73 de pacienţi au prezentat MHEHCR. Analiza univariată a fost efectuată pentru identificarea acelor factori de risc ce influenţează supravieţuirea generală (SG) . Rezultate: Au fost 20 de metastaze extrahepatice localizate la nivelul pediculului hepatic, 20 la nivel peritoneal, 12 la nivel ovarian şi pulmonar, 9 cu alte localizări şi 12 recidive locale. Au fost efectuate 53 de rezecţii curative (RO). Supravieţuirea Original ArticleChirurgia (2017) comparativă între lotul pacienţilor cu MHEHCR şi cel al pacienţilor cu metastaze strict hepatice a arătat o diferenţă semnificativă statistic în favoarea celui de-al doilea lot (p <0,0001), acelaşi rezultat fiind înregistrat şi în prezenţa rezecţiei R0 în cele două loturi (p <0,0001). În grupul MHEHCR, SG a fost semnificativă statistic mai mare la pacienţii care au beneficiat de rezecţie R0 faţă de cei la care rezecţia a fost R1/R2 (p = 0,004). Analiza univariată a identificat trei variabile drept factori de prognostic negativ pentru SG: 4 sau mai multe metastaze hepatice, efectuarea unei hepatectomii majore şi perioada realizării rezecţiei hepatice (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). Localizarea ovariană sau pulmonară a metastazelor extrahepatice este corelată cu cea mai bună rată de supravieţuire dintre toate localizările posibile dar fară a fi semnificativă statistic. Concluzie: La pacienţii cu metastaze hepatice şi extrahepatice concomitente, rezecţia completă (R0) a acestora prelungeşte în mod semnificativ supravieţuirea. Pacienţii cu mai puţin de 4 metastaze hepatice, a căror rezecţie este realizată printr-o hepatectomie minoră sunt cei care beneficiază cel mai mult de pe urma acestei conduite terapeutice onco-chirurgicale agresive.Cuvinte cheie: metastaze hepatice ale cancerului colo-rectal, metastaze extrahepatice, metastaze hepatice şi extrahepatice ale cancerului colo-rectal, rezecţie hepatică, supravieţuire generală, factori de prognostic AbstractBackground: The benefit of hepatic resection in case of concomitant colorectal hepatic and extrahepatic metastases (CHEHMs) is still debatable. The purpose of this study is to assess the results of resection of hepatic and extrahepatic metastases in patients with CHEHMs in a high-volume center for both hepatobiliary and colorectal surgery and to identify progn...

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Section: Introductionmentioning

confidence: 99%

Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Diaconescu¹,

Alexandrescu²,

Ionel³

et al. 2017

chr

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“…One possible explanation of the relevant efficacy of resection approaches is that the hepatic involvement occurs in a relatively early phase of the disease, when tumor cells do not express the end-stage aggressive phenotype (14). At present, it is not clear if all patients with hepatic lesions should undergo surgical evaluation (15). Up to some years ago, patients were selected on the basis of exclusion criteria referring to a higher risk of postsurgical relapse (16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Role of systemic chemotherapy in the management of resected or resectable colorectal liver metastases: a systematic review and meta-analysis of randomized controlled trials

et al. 2012

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Abstract. Liver metastases are a common event in patients with colorectal cancer. Surgical resection, if feasible, produces a survival benefit. We performed a systematic review of randomized clinical trials (RCT) and meta-analysis to address the question if current available studies support the use of systemic chemotherapy as an adjunct to surgery in resected/ resectable patients. The search was based on major databases (PubMed, CancerLit, Embase, Medscape and Cochrane) of published literature and selecting abstracts from major cancer meetings. We performed a literature for the January 1982-May 2010 time frame. The hazard ratios (HRs), with confidence intervals, as presented in retrieved studies, referred to the disease-and/or progression-free (DFS and/or PFS) and overall survival (OS) were extracted. The meta-analysis was carried out by the fixed-effect and the random-effects model. Three studies randomizing combined treatment vs. surgery alone for a total of 666 patients (642 evaluable for survival analysis) were selected and included in the final analysis. Evidence for chemotherapy-induced benefit in terms of both DFS (pooled HR, 0.71; CI, 0.582-0.878; P=0.001) and PFS (pooled HR, 0.75; CI, 0.620-0.910; P=0.003) was demonstrated. However, our meta-analysis failed to demonstrate a significant advantage of combined treatment in terms of OS (pooled HR, 0.743; CI, 0.527-1.045; P=0.088). Chemotherapy combined with surgical resection of colorectal liver metastases improves DFS and PFS whereas the benefit in OS is not demonstrated on the basis of the available results of RCTs. New prospective trials in the era of targeted therapy are eagerly awaited on this specific topic.

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“…45 In colorectal cancer, patient-mortality is particularly associated with the occurrence of metastases in the peritoneum and the liver. 46,47 Syngenic mouse models are powerful tools to simulate human colorectal cancer development and progression. 5,48 In these models, the effectiveness of chemotherapy can be assessed by the frequency of tumor cell apoptosis.…”

Section: Discussionmentioning

confidence: 99%

Fluorescence lifetime imaging microscopy of chemotherapy‐induced apoptosis resistance in a syngenic mouse tumor model

Keese

Yagublu

Schwenke

et al. 2009

Intl Journal of Cancer

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During cancer therapy with DNA-damaging drug-agents, the development of secondary resistance to apoptosis can be observed. In the search for novel therapeutic approaches that can be used in these cases, we monitored chemotherapyinduced apoptosis resistance in a syngenic mouse tumor model. For this, syngenic murine colorectal carcinoma cells, which stably expressed a FRET-based caspase-3 activity sensor, were introduced into animals to induce peritoneal carcinomatosis or disseminated hepatic metastases. This syngenic system allowed in vitro, in vivo and ex vivo analysis of chemotherapy induced apoptosis induction by optically monitoring the caspase-3 sensor state in the tumor cells. Tumor tissue analysis of 5-FU treated mice showed the selection of 5-FU-induced apoptosis resistant tumor cells. These and chemo-naive fluorescent tumor cells could be re-isolated from treated and untreated mice and propagated in cell culture. Re-exposure to 5-FU and second line treatment modalities in this ex-vivo setting showed that 5-FU induced apoptosis resistance could be alleviated by imatinib mesylate (Gleevec). We thus show that syngenic mouse systems that stably express a FRET-based caspase-3 sensor can be employed to analyse the therapeutic efficiency of apoptosis inducing chemotherapy.

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Resection of Colorectal Liver Metastases: Current Perspectives

Cited by 74 publications

References 114 publications

Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Role of systemic chemotherapy in the management of resected or resectable colorectal liver metastases: a systematic review and meta-analysis of randomized controlled trials

Fluorescence lifetime imaging microscopy of chemotherapy‐induced apoptosis resistance in a syngenic mouse tumor model

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