Surgical Resection of Hepatic and Pulmonary Metastases from Colorectal Carcinoma

Shah, Shimul A.; Haddad, Riad; Al-Sukhni, Wigdan; Kim, Robin D.; Greig, Paul D.; Grant, David; Taylor, Bryce; Langer, Bernard; Gallinger, Steven; Wei, Alice C.

doi:10.1016/j.jamcollsurg.2005.11.008

Cited by 247 publications

(143 citation statements)

References 33 publications

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“…This should be kept in mind particularly in view of the complication rate linked to surgery which is much higher [20e22]. In addition, RFA was repeated in nearly 80% of cases [9] as opposed to resective surgery [21]. These data confirm that RFA is an extremely versatile technique which can be repeated in the same patient to treat new metastases and in cases of incomplete treatment.…”

Section: Discussionmentioning

confidence: 80%

Radiofrequency ablation of metastatic lesions from breast cancer

Bortolotto

Macchi

Veronese

et al. 2012

Journal of Ultrasound

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KEYWORDSBreast carcinoma; Liver metastases; Pulmonary metastases; Radiofrequency ablation.Abstract Introduction: Breast cancer (BC) is the most common malignancy in women. Various studies [5,6] have shown that surgical resection of single liver or lung metastases in patients with metastases from BC increases survival. Radiofrequency ablation (RFA) can be an alternative to resection in some patients when resection is not feasible. Materials and methods: From January 2002 to December 2008, 491 patients with liver metastases underwent US-guided percutaneous RFA. Of these patients 5 (5/491; 1%) had BC. In the same period, 32 patients with pulmonary metastases underwent CT-guided RFA. Of these patients 3 (3/32; 9%) had BC. Mean age was 61.3 years. All patients were postmenopausal and receiving polychemotherapy according to international guidelines. Inclusion criteria for RFA treatment of metastases from BC applied are identical or in some cases more restrictive than those reported in the literature. Results: There were no deaths or severe complications and no treatment failures. Disease free and overall median survival were respectively 7.65 and 25.7 months after US-guided RFA and 13.4 and 34.8 months after CT-guided RFA. During follow-up (mean follow-up 26 months, range 4e63 months) 5/8 (62.5%) patients exhibited recurrence: 3/5 (60%) had local recurrence and 2/5 (40%) had non-local recurrence; 4/5 patients with recurrence were re-treated. Discussion: The authors' experience confirms that RFA is an effective, safe and repeatable technique in the treatment of metastases from BC. Metastatic recurrence rate confirms that metastatic BC is a disease which requires a multidisciplinary approach and that the role of chemotherapy is indisputable. Effects on survival are promising but further confirmation is needed through prospective randomized studies.Sommario Introduzione: Il carcinoma della mammella (BC) è la più frequente neoplasia nel sesso femminile. Vari studi hanno dimostrato che la resezione chirurgica delle MTS epatiche o polmonari singole determina un allungamento della sopravvivenza. La termoablazione a radiofrequenze (RFA) potrebbe rappresentare una valida alternativa alla resezione quando la prima non è fattibile. Materiali e metodi: Presso il nostro centro nel periodo compreso tra gennaio 2002 e dicembre 2008 sono stati trattati con RFA percutanea US-guidata 491 pazienti affetti da MTS epatiche di cui 5 (5/491; 1%) da BC. Nello stesso periodo sono stati trattati con RFA CT-guidata 32 pazienti con MTS polmonari: 3 (3/32; 9%) da BC. L'età media delle pazienti era di 61,3 anni. Tutte le pazienti erano in fase post-menopausale e in trattamento polichemioterapico in accordo con le linee guida internazionali. Le indicazioni per il trattamento delle metastasi da BC utilizzate nel nostro centro sono sovrapponibili o in alcuni casi maggiormente restrittive rispetto a quelle presenti in letteratura. Risultati: Non si sono verificati decessi o complicanze gravi. Non ci sono stati fallimenti terapeutici. La median surviva...

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Section: Discussionmentioning

confidence: 80%

Radiofrequency ablation of metastatic lesions from breast cancer

Bortolotto

Macchi

Veronese

et al. 2012

Journal of Ultrasound

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“…It is recognized that the incidence rate for colon cancer has been decreasing recently (23,24), likely due to increased efficacy in screening modalities and improved compliance with screening guidelines (25,26). Operations for patients with metastatic colon cancer, however, have been increasing as the safety profiles of these operations have improved and evidence has emerged supporting improved survival outcomes with resection of certain metastases (23,(27)(28)(29)(30). Our study confirms a trend toward a more aggressive surgical approach, specifically in patients with SHM, which has been demonstrated in previous studies (31,32).…”

Section: Discussionmentioning

confidence: 99%

Disparities in resection of hepatic metastases in colon cancer.

Neuwirth

Epstein

Karakousis

et al. 2017

JCO

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Background: Evidence suggests that resection of synchronous hepatic metastases (SHM) in stage IV colon cancer is safe and can improve survival in select patients. Little is known, however, about the use of hepatic resection in this setting on a population level. The aim of this study was to describe trends in resection rates of SHM in patients with stage IV colon cancer using a large national cohort database. Patients who were older with higher comorbidity burden were less likely to undergo hepatic resection. Additionally, the odds of hepatic resection were 30% lower for African-American patients than for white patients (OR 0.70, P=0.05). Odds of hepatic resection were 44% lower for patients from ZIP Codes with >20% poverty than for patients from areas with <5% poverty (OR 0.56, P<0.001). Interestingly, among patients who underwent no surgical treatment at all, only 25% saw a surgeon after diagnosis. This number increased over time from 21.6% in 2000 to 29.1% in 2011 (P<0.001). Similar disparities noted above were seen with surgical evaluation for hepatic resection. Conclusions: Despite evidence supporting the safety and efficacy of hepatic resection in the setting of SHM, few patients are seen by surgeons and go onto receive hepatic surgery. Additionally, access to hepatic resection is notably lower for African Americans and patients from areas with higher poverty rates.

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“…The relatively high survival of 74% reported by Shah et al 34 was calculated from the date of the first metastasectomy instead of the second (usually pulmonary) metastasectomy as used in several other studies; however, the median overall survival was still 42.2 months after the last metastasectomy. In this study, patients with synchronous or metachronous presentation of liver and lung metastases had no statistically significant difference in overall survival.…”

Section: Pulmonary Metastases Recommendationsmentioning

confidence: 99%

“…In cases of simultaneous hepatic and pulmonary metastases, several of the included studies state that hepatic metastasectomy was performed first. Shah et al 34 indicate that this order was used to maintain pulmonary reserve and to rule out unexpected extrahepatic abdominal disease. Lung resection was performed 6 or more weeks later.…”

Section: Qualifying Statementsmentioning

confidence: 99%

Liver Resection for Colorectal Cancer Metastases

et al. 2013

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These recommendations apply to patients with liver metastases from crc who have had or will have a complete (R0) resection of the primary cancer and who are being considered for resection of the liver, or liver plus specific and limited ehms, with curative intent. 1(a). Patients with liver and lung metastases should be seen in consultation with a thoracic surgeon. Combined or staged metastasectomy is recommended when, taking into account anatomic and physiologic considerations, the assessment is that all pulmonary metastases can also be completely removed. Furthermore, liver resection may be indicated in patients who have had a prior lung resection, and vice versa. 1(b). Routine liver resection is not recommended in patients with portal nodal disease. This group includes patients with radiologically suspicious portal nodes or malignant portal nodes found preoperatively or intraoperatively. Liver plus nodal resection, together with perioperative systemic therapy, may be an option-after a full discussion with the patient-in cases with limited nodal involvement and with metastases that can be completely resected. 1(c). Routine liver resection is not recommended in patients with nonpulmonary ehms. Liver plus extrahepatic resection, together with perioperative systemic therapy, may be an option-after a full discussion with the patient-for metastases that can be completely resected. 2(a). Perioperative chemotherapy, either before and after resection, or after resection, is recommended in patients with resectable ABSTRACT Questions1. Should surgery be considered for colorectal cancer (crc) patients who have liver metastases plus (a) pulmonary metastases, (b) portal nodal disease, or (c) other extrahepatic metastases (ehms)? 2. What is the role of chemotherapy in the surgical management of crc with liver metastases in (a) patients with resectable disease in the liver, or (b) patients with initially unresectable disease in the liver that is downsized with chemotherapy ("conversion")? 3. What is the role of liver resection when one or more crc liver metastases have radiographic complete response (rcr) after chemotherapy? PerspectivesAdvances in chemotherapy have improved survival in crc patients with liver metastases. The 5-year survival with chemotherapy alone is typically less than 1%, although two recent studies with folfox or folfoxiri (or both) reported rates of 5%-10%. However, liver resection is the treatment that is most effective in achieving long-term survival and offering the possibility of a cure in stage iv crc patients with liver metastases. This guideline deals with the role of chemotherapy with surgery, and the role of surgery when there are liver metastases plus ehms. Because only a proportion of patients with crc metastatic disease are considered for liver resection, and because management of this patient population is complex, multidisciplinary management is required. MethodologyRecommendations in the present guideline were formulated based on a prepublication version of a recent systematic review on th...

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Surgical Resection of Hepatic and Pulmonary Metastases from Colorectal Carcinoma

Cited by 247 publications

References 33 publications

Radiofrequency ablation of metastatic lesions from breast cancer

Radiofrequency ablation of metastatic lesions from breast cancer

Disparities in resection of hepatic metastases in colon cancer.

Liver Resection for Colorectal Cancer Metastases

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