Systematic review of surgical management of synchronous colorectal liver metastases

Lykoudis, Panagis M.; O’Reilly, David; Nastos, Konstantinos; Fusai, Giuseppe

doi:10.1002/bjs.9449

Cited by 108 publications

(101 citation statements)

References 42 publications

(104 reference statements)

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“…At CRC diagnosis, 20-25% of patients have stage IV disease [2][3][4][5], in which synchronous CRC liver metastases (CRCLM) are present in 15-25% of cases [6] and metastases are confined to the liver in 70-80% of these cases [7]. Surgical resection is the most effective treatment approach for CRCLM, but only a minority of patients are suitable for upfront surgery [8].…”

Section: Introductionmentioning

confidence: 99%

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Adam

Gramont

Figueras

et al. 2015

Cancer Treatment Reviews

488

413

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a b s t r a c tAn international panel of multidisciplinary experts convened to develop recommendations for managing patients with colorectal cancer (CRC) and synchronous liver metastases (CRCLM). A modified Delphi method was used. CRCLM is defined as liver metastases detected at or before diagnosis of the primary CRC. Early and late metachronous metastases are defined as those detected 612 months and >12 months after surgery, respectively. To provide information on potential curability, use of high-quality contrast-enhanced computed tomography (CT) before chemotherapy is recommended. Magnetic resonance imaging is increasingly being used preoperatively to aid detection of subcentimetric metastases, Contents lists available at ScienceDirectCancer Treatment Reviews j o u r n a l h o m e p a g e : w w w . e l s e v i e r h e a l t h . c o m / j o u r n a l s / c t r v and alongside CT in difficult situations. To evaluate operability, radiology should provide information on: nodule size and number, segmental localization and relationship with major vessels, response after neoadjuvant chemotherapy, non-tumoral liver condition and anticipated remnant liver volume. Pathological evaluation should assess response to preoperative chemotherapy for both the primary tumour and metastases, and provide information on the tumour, margin size and micrometastases. Although the treatment strategy depends on the clinical scenario, the consensus was for chemotherapy before surgery in most cases. When the primary CRC is asymptomatic, liver surgery may be performed first (reverse approach). When CRCLM are unresectable, the goal of preoperative chemotherapy is to downsize tumours to allow resection. Hepatic resection should not be denied to patients with stable disease after optimal chemotherapy, provided an adequate liver remnant with inflow and outflow preservation remains. All patients with synchronous CRCLM should be evaluated by a hepatobiliary multidisciplinary team.

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Section: Introductionmentioning

confidence: 99%

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Adam

Gramont

Figueras

et al. 2015

Cancer Treatment Reviews

488

413

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“…Existen varios trabajos de revisiones 17,21,23,24 y en todas ellas los autores encuentran los mismos problemas: 1) La definición de MHCRS no es la misma para todos los autores; 2) Son trabajos retrospectivos; 3) no siempre se comparan grupos con MHCRS y estrategias diferentes sino que son series de resultados con una u otra estrategia y 4) En general, los candidatos a cirugía simultánea son mejores que los de cirugía secuencial. Con estos datos, la mayoría coinciden en que la cirugía simultánea se puede realizar con los mismos resultados sólo en casos seleccionados, pero, en pacientes con peor status preoperatorio o candidatos a resecciones hepáticas mayores, la cirugía secuencial sería la indicada, con menor morbimortalidad y ahorrando posiblemente alguna intervención hepática innecesaria 15,17,23,24 .…”

Section: Supervivenciaunclassified

“…El número de MH fue mayor en el grupo 2, algo esperable, ya que la cirugía simultánea la realizamos sólo en casos de 3 o menos metástasis hepáticas tal y como recomiendan la mayoría de los autores 12,21,23,24 . Por el mismo motivo el índice de resecabilidad fue mayor en el grupo 1 así como el porcentaje de resecciones hepáticas aunque sin significación estadística.…”

Section: Supervivenciaunclassified

“…El índice de resecabilidad global fue de 77,6%, menor que en otras series de nuestro entorno y tal vez por eso, unido a que las intervenciones hepáticas fueron realizadas por el mismo cirujano, la morbilidad global es menor y no hemos tenido complicaciones mayores ni diferencias entre ambos grupos 4,7,12,15,[21][22][23]27,28 (Tabla 3), a pesar de que tenemos 46 pacientes ASA 3, por lo que no creemos que el status preoperatorio deba influir para elegir una u otra estrategia.…”

Section: Supervivenciaunclassified

“…La supervivencia a 1, 3 y 5 años fue de 75%, 45% y 36% en el grupo 1 y de 76%, 49% y 29% en el grupo 2, cifras similares a las encontradas en la literatura [5][6][7]12,15,[20][21][22][23][24]29 (Tabla 3) sin diferencias significativas entre ambos grupos.…”

Section: Supervivenciaunclassified

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Metástasis Hepáticas De Origen Colorrectal Sincrónicas: ¿intervención Simultánea O Secuencial?

et al. 2015

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simultaneous or sequential treatment of liver metastases of colon cancer? experience in 76 patientsBackground: Synchronous liver metastases of colon cancer can be managed with sequential or simultaneous surgical management of the primary tumor and the metastases. aim: To compare the evolution of patients whose liver metastases were treated sequentially or simultaneously. Material and Methods: Retrospective analysis of 76 patients aged 63 ± 11 years (67% males). In 25, metastases were managed simultaneously and in 51 there were treated sequentially after a period of chemotherapy. All interventions were performed by the same surgeon. results: Patients treated sequentially had a higher number of metastases and more lymph nodes involved than their counterparts treated simultaneously. The overall resectability index was 78%. Eighteen major and 28 minor hepatic resections were carried out. Significantly more major resections were carried out in the sequential treatment group. Mean hospital stay was 11 days and 20% of patients had complications, with no differences between groups. Survival at one, three and five years was 75, 45 and 36% in the simultaneous treatment and 76, 49 and 29% in the sequential treatment group (with no significant differences between groups). conclusions: In this group of patients no differences in complications or survival were observed when liver metastases were treated simultaneously or sequentially. However groups were not homogeneous.

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Association of Simultaneous vs Delayed Resection of Liver Metastasis With Complications and Survival Among Adults With Colorectal Cancer

Mao

Wang

et al. 2022

JAMA Netw Open

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ImportanceSimultaneous or delayed resection of synchronous liver metastasis (SLM) with primary colorectal cancer (CRC) remains a controversial topic.ObjectiveTo investigate the outcomes of simultaneous vs delayed resection in patients with resectable SLM.Design, Setting, and ParticipantsThis comparative effectiveness research study included 1569 patients with resectable SLM who underwent curative-intent liver resection at 3 independent centers in China between January 1, 2000, to December 31, 2019. A 1:1 propensity score matching was performed. Follow-up was completed on August 31, 2021, and the data were analyzed from April 1 to 30, 2022.Main Outcomes and MeasuresPrimary outcome was the percentage of patients with at least 1 major complication within 60 days after surgery. Secondary outcomes were intraoperative and postoperative complications, overall survival (OS), and cancer-specific survival (CSS) rates.ResultsAmong the 1569 patients included, 1057 (67.4%) underwent delayed resection (719 men [68.0%] with a mean [SD] age of 57.4 [11.2] years), and 512 patients (310 men [60.5%] with a mean [SD] age of 57.1 [10.5] years) underwent simultaneous resection. Matching yielded 495 pairs of patients underwent simultaneous resection. The percentage of major perioperative complications did not differ between the simultaneous and delayed resection groups (34.1% vs 30.0%; P = .89). The OS rates were 65.2% at 3 years, 47.1% at 5 years, and 38.0% at 8 years for the delayed resection group and 78.0% at 3 years, 65.4% at 5 years, and 63.1% at 8 years for the simultaneous resection group (hazard ratio [HR], 1.42; 95% CI, 1.10-1.85, P = .003). The CSS rates were 68.3% at 3 years, 48.5% at 5 years, and 37.1% at 8 years for the delayed resection group and 79.2% at 3 years, 67.2% at 5 years, and 65.9% at 8 years for the simultaneous resection group (HR, 1.45; 95% CI, 1.14-1.98; P = .004). On subgroup analysis comparing the 2 strategies according to the KRAS sequence variation status, the OS rates (HR, 1.61; 95% CI, 1.45-2.18; P < .001) and CSS rates (HR, 1.62; 95 CI, 1.40-1.87; P = .003]) in the simultaneous resection group were significantly better than those in the delayed resection group in patients with KRAS wild-type tumors.Conclusions and RelevanceResults of this study suggest that complication rates did not differ when CRC and SLM were resected simultaneously and that the survival benefits of simultaneous resection were restricted to patients with KRAS wild-type tumors. Integrating molecular features into the treatment decision is a basis for accurate, individualized treatments.

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Systematic review of surgical management of synchronous colorectal liver metastases

Abstract: None of the three surgical strategies for synchronous colorectal liver metastases appeared inferior to the others.

Cited by 108 publications

References 42 publications

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Metástasis Hepáticas De Origen Colorrectal Sincrónicas: ¿intervención Simultánea O Secuencial?

Association of Simultaneous vs Delayed Resection of Liver Metastasis With Complications and Survival Among Adults With Colorectal Cancer

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