Top

Published in:

01-09-2012

Liver Resection for Multiple Colorectal Liver Metastases with Surgery Up-front Approach: Bi-institutional Analysis of 736 Consecutive Cases

Authors: Akio Saiura, Junji Yamamoto, Kiyoshi Hasegawa, Rintaro Koga, Yoshihiro Sakamoto, Shojiro Hata, Masatoshi Makuuchi, Norihiro Kokudo

Published in: World Journal of Surgery | Issue 9/2012

Abstract

Background

Preoperative chemotherapy has become more common in the management of multiple resectable colorectal liver metastases; however, the benefit is unclear. This study examined clinical outcomes following liver resection for multiple colorectal liver metastases with the surgery up-front approach.

Methods

Data collected prospectively over a 16-year period for 736 patients who underwent hepatic resection at two different centers were reviewed. Patients were divided into three groups depending on the number of tumors as follows: group A, between one and three tumors (n = 493); group B, between four and seven tumors (n = 141); and group C, eight or more tumors (n = 102).

Results

The 5-year overall and recurrence-free survival rates were 51 and 21 %, respectively, for the entire patient cohort, 56 and 29 % in group A, 41 and 12 % in group B, and 33 and 1.7 % in group C. Multivariate analysis showed that decreased survival was associated with positive lymph node metastasis of the primary tumor, the presence of extrahepatic tumors, a maximum liver tumor size >5 cm, and tumor exposure during liver resection.

Conclusions

In patients with multiple liver metastases, the number of liver metastases has less impact on the prognosis than other prognostic factors. Complete resection with repeat metastasectomy offers a chance of cure even in patients with numerous colorectal liver metastases (i.e., those with eight or more nodules). A further prospective study is necessary to clarify the optimal setting of preoperative chemotherapy.

Rees M, Tekkis PP, Welsh FK et al (2008) Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg 247:125–135PubMedCrossRef

de Haas RJ, Wicherts DA, Flores E et al (2008) R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg 248:626–637PubMed

McCarter MD, Fong Y (2000) Metastatic liver tumors. Semin Surg Oncol 19:177–188PubMedCrossRef

Pawlik TM, Schulick RD, Choti MA (2008) Expanding criteria for resectability of colorectal liver metastases. Oncologist 13:51–64PubMedCrossRef

Adson MA (1987) Resection of liver metastases–when is it worthwhile? World J Surg 11:511–520. doi:10.1007/BF01655817 PubMedCrossRef

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

Simmonds PC, Primrose JN, Colquitt JL et al (2006) Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 94:982–999PubMedCrossRef

Adam R, Delvart V, Pascal G et al (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240:644–657 (discussion 657–648)PubMedCrossRef

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 230:309–318 (discussion 318–321)PubMedCrossRef

10.

Oussoultzoglou E, Rosso E, Fuchshuber P et al (2008) Perioperative carcinoembryonic antigen measurements to predict curability after liver resection for colorectal metastases: a prospective study. Arch Surg 143:1150–1158 (discussion 1158–1159)PubMedCrossRef

11.

Malik HZ, Hamady ZZ, Adair R et al (2007) Prognostic influence of multiple hepatic metastases from colorectal cancer. Eur J Surg Oncol 33:468–473PubMedCrossRef

12.

Smith MD, McCall JL (2009) Systematic review of tumour number and outcome after radical treatment of colorectal liver metastases. Br J Surg 96:1101–1113PubMedCrossRef

13.

Ekberg H, Tranberg KG, Andersson R et al (1986) Determinants of survival in liver resection for colorectal secondaries. Br J Surg 73:727–731PubMedCrossRef

14.

Torzilli G, Procopio F, Botea F et al (2009) One-stage ultrasonographically guided hepatectomy for multiple bilobar colorectal metastases: a feasible and effective alternative to the 2-stage approach. Surgery 146:60–71PubMedCrossRef

15.

Weber JC, Nakano H, Bachellier P et al (2001) Is a proliferation index of cancer cells a reliable prognostic factor after hepatectomy in patients with colorectal liver metastases? Am J Surg 182:81–88PubMedCrossRef

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 231:487–499PubMedCrossRef

17.

Adam R, Haller DG, Poston G et al (2009) Toward optimized front-line therapeutic strategies in patients with metastatic colorectal cancer—an expert review from the International Congress on Anti-Cancer Treatment (ICACT) 2009. Ann Oncol 21:1579–1584CrossRef

18.

Nordlinger B, Sorbye H, Glimelius B et al (2008) Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet 371:1007–1016PubMedCrossRef

19.

Karoui M, Penna C, Amin-Hashem M et al (2006) Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 243:1–7PubMedCrossRef

20.

Welsh FK, Tilney HS, Tekkis PP et al (2007) Safe liver resection following chemotherapy for colorectal metastases is a matter of timing. Br J Cancer 96:1037–1042PubMedCrossRef

21.

Adam R, Bhangui P, Poston G et al (2011) Is perioperative chemotherapy useful for solitary, metachronous, colorectal liver metastases? Ann Surg 252:774–787CrossRef

22.

Couinaud C (1957) Etudes Anatomicales et Chirurgicales. Masson & Cie, Paris, pp 187–208

23.

Kokudo N, Hasegawa K, Makuuchi M (2007) Control arm for surgery alone is needed but difficult to obtain in randomized trials for adjuvant chemotherapy after liver resection for colorectal metastases. J Clin Oncol 25:1299–1300 author reply 1300PubMedCrossRef

24.

Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196PubMedCrossRef

25.

Adam R (2007) Colorectal cancer with synchronous liver metastases. Br J Surg 94:129–131PubMedCrossRef

26.

de Haas RJ, Adam R, Wicherts DA et al (2010) Comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases. Br J Surg 97:1279–1289PubMedCrossRef

27.

de Haas RJ, Wicherts DA, Andreani P et al (2011) Impact of expanding criteria for resectability of colorectal metastases on short- and long-term outcomes after hepatic resection. Ann Surg 253:1069–1079PubMedCrossRef

28.

Blazer DG III, Kishi Y, Maru DM et al (2008) Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases. J Clin Oncol 26:5344–5351PubMedCrossRef

29.

Topp SA, McClurken M, Lipson D et al (2004) Saline-linked surface radiofrequency ablation: factors affecting steam popping and depth of injury in the pig liver. Ann Surg 239:518–527PubMedCrossRef

30.

Arru M, Aldrighetti L, Castoldi R et al (2008) Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer. World J Surg 32:93–103. doi:10.1007/s00268-007-9285-y PubMedCrossRef

31.

Yamamoto J, Kosuge T, Shimada K et al (1999) Repeat liver resection for recurrent colorectal liver metastases. Am J Surg 178:275–281PubMedCrossRef

32.

Adam R, Pascal G, Azoulay D et al (2003) Liver resection for colorectal metastases: the third hepatectomy. Ann Surg 238:871–883 (discussion 883–874)PubMedCrossRef

33.

Pessaux P, Lermite E, Brehant O et al (2006) Repeat hepatectomy for recurrent colorectal liver metastases. J Surg Oncol 93:1–7PubMedCrossRef

34.

Yan TD, Sim J, Black D et al (2007) Systematic review on safety and efficacy of repeat hepatectomy for recurrent liver metastases from colorectal carcinoma. Ann Surg Oncol 14:2069–2077PubMedCrossRef

35.

Nishio H, Hamady ZZ, Malik HZ et al (2007) Outcome following repeat liver resection for colorectal liver metastases. Eur J Surg Oncol 33:729–734PubMedCrossRef

Title: Liver Resection for Multiple Colorectal Liver Metastases with Surgery Up-front Approach: Bi-institutional Analysis of 736 Consecutive Cases
Authors: Akio Saiura
Junji Yamamoto
Kiyoshi Hasegawa
Rintaro Koga
Yoshihiro Sakamoto
Shojiro Hata
Masatoshi Makuuchi
Norihiro Kokudo
Publication date: 01-09-2012
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 9/2012
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-012-1616-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Liver Resection for Multiple Colorectal Liver Metastases with Surgery Up-front Approach: Bi-institutional Analysis of 736 Consecutive Cases

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 9/2012

Clinicopathologic Profile of Benign Breast Conditions in Indian Women: Prospective Study Based on Aberrations of Normal Development and Involution Classification

Dementia and Poor Surgical Outcomes: Reinventing the Wheel or Providing Empirical Evidence?

Effect of Chronic Anal Fissure Components on Isosorbide Dinitrate Treatment

One- and Two-Year Outcomes and Predictors of Mortality Following Emergency Laparotomy: A Consecutive Series from a United Kingdom Teaching Hospital

Erratum to: The Appendicitis Inflammatory Response Score: A Tool for the Diagnosis of Acute Appendicitis that Outperforms the Alvarado Score

Erratum to: Evaluation of the Appendicitis Inflammatory Response Score for Patients with Acute Appendicitis