Top

World Journal of Surgery

Published in:

01-09-2010

Clinical Risk Score Can be Used to Select Patients for Staging Laparoscopy and Laparoscopic Ultrasound for Colorectal Liver Metastases

Authors: A. J. Shah, J. Phull, M. D. Finch-Jones

Published in: World Journal of Surgery | Issue 9/2010

Abstract

Background

Despite advanced staging investigations, some patients with potentially resectable colorectal liver metastases (CLM) are unresectable at laparotomy. Staging laparoscopy and laparoscopic ultrasound (Lap + LUS) detects a subset of these unresectable patients before a major laparotomy. Clinical risk scoring may be helpful to identify this subgroup. The goal of our study was to evaluate the role of Lap + LUS and to assess the value of the Memorial Sloan Kettering clinical risk score (CRS) in identifying this subset.

Methods

Patients were identified from the regional multidisciplinary team (MDT) cancer database and operative records for a 5-year period. All patients whose tumors were deemed resectable proceeded to Lap + LUS. LUS findings were recorded and any change in MDT plan was noted. LUS findings were compared with resectability at open surgery. The CRS (Memorial Sloan-Kettering) based on five factors was calculated.

Results

A total of 79 patients were identified. In 15 of 74 patients, LUS prevented an unnecessary laparotomy by predicting the benign nature of lesions or demonstrating unresectability. The CRS ranged from 0 to 4. Lap + LUS prevented an operation in only 7% of patients with a CRS of ≤2. However in patients with a CRS > 2, Lap + LUS prevented an operation in 24% of patients.

Conclusions

LUS prevented an unnecessary laparotomy in 20% of patients. This may reduce inpatient stay, morbidity, and mortality, allowing some patients to proceed to palliative treatments earlier. The benefit of Lap + LUS is limited in patients with a CRS of ≤2. It is worth considering selective use of Lap + LUS for the staging of CLM.

Weitz J, Koch M, Debus J et al (2005) Colorectal cancer. Lancet 365(9454):153–165CrossRefPubMed

Steele G Jr, Ravikumar TS (1989) Resection of hepatic metastases from colorectal cancer. Biologic perspective. Ann Surg 210(2):127–138CrossRefPubMed

Geoghegan JG, Scheele J (1999) Treatment of colorectal liver metastases. Br J Surg 86(2):158–169CrossRefPubMed

Jatzko G, Wette V, Muller M et al (1991) Simultaneous resection of colorectal carcinoma and synchronous liver metastases in a district hospital. Int J Colorectal Dis 6(2):111–114CrossRefPubMed

Blumgart LH, Allison DJ (1982) Resection and embolization in the management of secondary hepatic tumors. World J Surg 6(1):32–45CrossRefPubMed

Finlay IG, McArdle CS (1986) Occult hepatic metastases in colorectal carcinoma. Br J Surg 73(9):732–735CrossRefPubMed

Scheele J, Stang R, Altendorf-Hofmann A, Paul M (1995) Resection of colorectal liver metastases. World J Surg 19(1):59–71CrossRefPubMed

Scheele J, Stangl R, Altendorf-Hofmann A, Gall FP (1991) Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 110(1):13–29PubMed

Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230(3):309–318 (discussion 318–321)CrossRefPubMed

10.

Are C, Gonen M, Zazzali K et al (2007) The impact of margins on outcome after hepatic resection for colorectal metastasis. Ann Surg 246(2):295–300CrossRefPubMed

11.

Choti MA, Sitzmann JV, Tiburi MF et al (2002) Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 235(6):759–766CrossRefPubMed

12.

Fernandez FG, Drebin JA, Linehan DC et al (2004) Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg 240(3):438–447 (discussion 447–450)CrossRefPubMed

13.

Laurent C, Sa Cunha A, Couderc P et al (2003) Influence of postoperative morbidity on long-term survival following liver resection for colorectal metastases. Br J Surg 90(9):1131–1136CrossRefPubMed

14.

Pawlik TM, Scoggins CR, Zorzi D et al (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241(5):715–722 (discussion 722–724)CrossRefPubMed

15.

Shaw IM, Rees M, Welsh FK et al (2006) Repeat hepatic resection for recurrent colorectal liver metastases is associated with favourable long-term survival. Br J Surg 93(4):457–464CrossRefPubMed

16.

Minagawa M, Makuuchi M, Torzilli G et al (2000) Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg 231(4):487–499CrossRefPubMed

17.

Andre T, Tournigand C, Mineur L et al (2007) Phase II study of an optimized 5-fluorouracil-oxaliplatin strategy (OPTIMOX2) with celecoxib in metastatic colorectal cancer: a GERCOR study. Ann Oncol 18(1):77–81CrossRefPubMed

18.

de Gramont A, Figer A, Seymour M et al (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18(16):2938–2947PubMed

19.

Giantonio BJ, Catalano PJ, Meropol NJ et al (2007) Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol 25(12):1539–1544CrossRefPubMed

20.

Goldberg RM, Sargent DJ, Morton RF et al (2004) A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 22(1):23–30CrossRefPubMed

21.

Masi G, Allegrini G, Cupini S et al (2004) First-line treatment of metastatic colorectal cancer with irinotecan, oxaliplatin and 5-fluorouracil/leucovorin (FOLFOXIRI): results of a phase II study with a simplified biweekly schedule. Ann Oncol 15(12):1766–1772CrossRefPubMed

22.

Seium Y, Stupp R, Ruhstaller T et al (2005) Oxaliplatin combined with irinotecan and 5-fluorouracil/leucovorin (OCFL) in metastatic colorectal cancer: a phase I-II study. Ann Oncol 16(5):762–766CrossRefPubMed

23.

Stathopoulos GP, Rigatos SK, Stathopoulos JG et al (2005) Efficacy and tolerability of oxaliplatin plus irinotecan 5-fluouracil and leucovorin regimen in advanced stage colorectal cancer patients pretreated with irinotecan 5-fluouracil and leucovorin. Am J Clin Oncol 28(6):565–569CrossRefPubMed

24.

Adam R, Avisar E, Ariche A et al (2001) Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal. Ann Surg Oncol 8(4):347–353CrossRefPubMed

25.

Capussotti L, Muratore A, Mulas MM et al (2006) Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. Br J Surg 93(8):1001–1006CrossRefPubMed

26.

Sjovall A, Jarv V, Blomqvist L et al (2004) The potential for improved outcome in patients with hepatic metastases from colon cancer: a population-based study. Eur J Surg Oncol 30(8):834–841CrossRefPubMed

27.

John TG, Greig JD, Crosbie JL et al (1994) Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound. Ann Surg 220(6):711–719CrossRefPubMed

28.

Koea J, Rodgers M, Thompson P et al (2004) Laparoscopy in the management of colorectal cancer metastatic to the liver. ANZ J Surg 74(12):1056–1059CrossRefPubMed

29.

Metcalfe MS, Close JS, Iswariah H et al (2003) The value of laparoscopic staging for patients with colorectal metastases. Arch Surg 138(7):770–772CrossRefPubMed

30.

Rahusen FD, Cuesta MA, Borgstein PJ et al (1999) Selection of patients for resection of colorectal metastases to the liver using diagnostic laparoscopy and laparoscopic ultrasonography. Ann Surg 230(1):31–37CrossRefPubMed

31.

D’Angelica M, Fong Y, Weber S et al (2003) The role of staging laparoscopy in hepatobiliary malignancy: prospective analysis of 401 cases. Ann Surg Oncol 10(2):183–189CrossRefPubMed

32.

Jarnagin WR, Fong Y, Ky A et al (1999) Liver resection for metastatic colorectal cancer: assessing the risk of occult irresectable disease. J Am Coll Surg 188(1):33–42CrossRefPubMed

33.

Mann CD, Neal CP, Metcalfe MS et al (2007) Clinical Risk Score predicts yield of staging laparoscopy in patients with colorectal liver metastases. Br J Surg 94(7):855–859CrossRefPubMed

34.

Huebner RH, Park KC, Shepherd JE et al (2000) A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med 41(7):1177–1189PubMed

35.

Ward J, Robinson PJ, Guthrie JA et al (2005) Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging. Radiology 237(1):170–180CrossRefPubMed

36.

Ruers TJ, Langenhoff BS, Neeleman N et al (2002) Value of positron emission tomography with [F-18]fluorodeoxyglucose in patients with colorectal liver metastases: a prospective study. J Clin Oncol 20(2):388–395CrossRefPubMed

37.

Strasberg SM, Dehdashti F, Siegel BA et al (2001) Survival of patients evaluated by FDG-PET before hepatic resection for metastatic colorectal carcinoma: a prospective database study. Ann Surg 233(3):293–299CrossRefPubMed

38.

Jarnagin WR, Conlon K, Bodniewicz J et al (2001) A clinical scoring system predicts the yield of diagnostic laparoscopy in patients with potentially resectable hepatic colorectal metastases. Cancer 91(6):1121–1128CrossRefPubMed

Title: Clinical Risk Score Can be Used to Select Patients for Staging Laparoscopy and Laparoscopic Ultrasound for Colorectal Liver Metastases
Authors: A. J. Shah
J. Phull
M. D. Finch-Jones
Publication date: 01-09-2010
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 9/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-010-0630-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical Risk Score Can be Used to Select Patients for Staging Laparoscopy and Laparoscopic Ultrasound for Colorectal Liver Metastases

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2010

The Political Economy of Emergency and Essential Surgery in Global Health

Central Lymph Node Metastasis: Is It a Reliable Indicator of Node Involvement in Papillary Thyroid Carcinoma? Letter to the Editor

Outcomes of Robot-Assisted Pancreaticoduodenectomy in Patients Older Than 70 Years: A Comparative Study

Atrial Resection for Lung Cancer: Morbidity, Mortality, and Long-Term Follow-up

Non-surgical Management Should be First-line Therapy for Breast Abscess: Reply

Predictive Value of Tumor Proliferative Indices in Periampullary Cancers: Ki-67, Mitotic Activity Index (MI) and Volume Corrected Mitotic Index (M/V) Using Tissue Microarrays