Top

Annals of Surgical Oncology

Published in:

01-09-2009 | Controversies in the Management of Hepatic Colorectal Metastases

Liver Resection for Metastatic Colorectal Cancer in the Presence of Extrahepatic Disease

Authors: Darren R. Carpizo, MD, PhD, Michael D’Angelica, MD

Published in: Annals of Surgical Oncology | Issue 9/2009

Abstract

Background

Hepatic resection for metastatic colorectal cancer (CRC) with concomitant extrahepatic disease (EHD) is controversial. Earlier reports of the results of liver resection for metastatic CRC identified patients with EHD as a group with poor outcomes, suggesting that the presence of EHD was an absolute contraindication to resection. This has recently been challenged in several reports due to advances in systemic chemotherapy, surgical technique, and patient selection.

Methods

This review was restricted to published data in the English language identified by searches of MEDLINE and Pubmed databases as well as reference lists of recent review articles on subjects of surgery for metastatic colorectal cancer.

Results

Five-year survival after resection is worse than patients with liver-only disease but approximates the survival rates seen in patients with resected liver-only metastases in the era prior to the use of modern chemotherapy. Recurrence occurs in the great majority of patients.

Conclusions

At this time, there appears to be a role for surgery in highly selected patients with a single site of EHD amenable to complete resection. Unlike patients with liver-only disease, however, the goals of surgery must not be viewed as potentially curative.

Tomlinson JS, Jarnagin WR, DeMatteo RP, Fong Y, Kornprat P, Gonen M, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25(29):4575–80.PubMedCrossRef

Adson MA, van Heerden JA, Adson MH, Wagner JS, Ilstrup DM. Resection of hepatic metastases from colorectal cancer. Arch Surg. 1984;119(6):647–51.PubMed

Ekberg HH, Tranberg KKG, Andersson RR, Lundstedt CC, Hägerstrand II, Ranstam JJ, et al. Determinants of survival in liver resection for colorectal secondaries. Br J Surg. 1986;73(9):727–31.PubMedCrossRef

Hughes KS, Simon R, Songhorabodi S, Adson MA, Ilstrup DM, Fortner JG, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence. Surgery. 1986;100(2):278–84.PubMed

Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239(6):818–25; discussion 825–7.PubMedCrossRef

Blumgart LLH, Fong YY. Surgical options in the treatment of hepatic metastasis from colorectal cancer. Curr Prob Surg. 1995;32(5):333–421.CrossRef

August DA, Sugarbaker PH, Schneider PD. Lymphatic dissemination of hepatic metastases. Implications for the follow-up and treatment of patients with colorectal cancer. Cancer. 1985;55(7):1490–4.PubMedCrossRef

Beckurts KT, Holscher AH, Thorban S, Bollschweiler E, Siewert JR. Significance of lymph node involvement at the hepatic hilum in the resection of colorectal liver metastases. Br J Surg. 1997;84(8):1081–4.PubMedCrossRef

Rosen CB, Nagorney DM, Taswell HF, Helgeson SL, Ilstrup DM, van Heerden JA, et al. Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma. Ann Surg. 1992;216(4):493–504; discussion 504–5.PubMedCrossRef

10.

Kokudo N, Sato T, Seki M, Ohta H, Azekura K, Ueno M, et al. Hepatic lymph node involvement in resected cases of liver metastases from colorectal cancer. Dis Colon Rectum. 1999;42(10):1285–90; discussion 1290–1.PubMedCrossRef

11.

Jaeck D, Nakano H, Bachellier P, Inoue K, Weber JC, Oussoultzoglou E, et al. Significance of hepatic pedicle lymph node involvement in patients with colorectal liver metastases: a prospective study. Ann Surg Oncol. 2002;9(5):430–8.PubMedCrossRef

12.

Elias D, Saric J, Jaeck D, Arnaud JP, Gayet B, Rivoire M, et al. Prospective study of microscopic lymph node involvement of the hepatic pedicle during curative hepatectomy for colorectal metastases. Br J Surg. 1996;83(7):942–5.PubMedCrossRef

13.

Ercolani G, Grazi GL, Ravaioli M, Grigioni WF, Cescon M, Gardini A, et al. The role of lymphadenectomy for liver tumors: further considerations on the appropriateness of treatment strategy. Ann Surg. 2004;239(2):202–9.PubMedCrossRef

14.

Grobmyer SR, Wang L, Gonen M, Fong Y, Klimstra D, D'Angelica M, et al. Perihepatic lymph node assessment in patients undergoing partial hepatectomy for malignancy. Ann Surg. 2006;244(2):260–4.PubMedCrossRef

15.

Laurent C, Sa Cunha A, Rullier E, Smith D, Rullier A, Saric J. Impact of microscopic hepatic lymph node involvement on survival after resection of colorectal liver metastasis. J Am Coll Surg. 2004;198(6):884–91.PubMedCrossRef

16.

Adam R, de Haas RJ, Wicherts DA, Aloia TA, Delvart V, Azoulay D, et al. Is hepatic resection justified after chemotherapy in patients with colorectal liver metastases and lymph node involvement? J Clin Oncol. 2008;26(22):3672–80.PubMedCrossRef

17.

Tan LK, Giri D, Hummer AJ, Panageas KS, Brogi E, Norton L, et al. Occult axillary node metastases in breast cancer are prognostically significant: results in 368 node-negative patients with 20-year follow-up. J Clin Oncol. 2008;26(11):1803–9.PubMedCrossRef

18.

Bennett JJ, Schmidt CR, Klimstra DS, Grobmyer SR, Ishill NM, D'Angelica M, et al. Perihepatic lymph node micrometastases impact outcome after partial hepatectomy for colorectal metastases. Ann Surg Oncol. 2008;15(4):1130–6.PubMedCrossRef

19.

Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230(3):309–18; discussion 318–21.PubMedCrossRef

20.

Higashiyama M, Kodama K, Higaki N, Takami K, Murata K, Kameyama M, et al. Surgery for pulmonary metastases from colorectal cancer: the importance of prethoracotomy serum carcinoembryonic antigen as an indicator of prognosis. Jpn J Thorac Cardiovasc Surg. 2003;51(7):289–96.PubMedCrossRef

21.

Lee WS, Yun SH, Chun HK, Lee WY, Yun HR, Kim J, et al. Pulmonary resection for metastases from colorectal cancer: prognostic factors and survival. Int J Colorectal Dis. 2007;22(6):699–704.PubMedCrossRef

22.

Rena O, Casadio C, Viano F, Cristofori R, Ruffini E, Filosso PL, et al. Pulmonary resection for metastases from colorectal cancer: factors influencing prognosis. Twenty-year experience. Eur J Cardiothorac Surg. 2002;21(5):906–12.PubMedCrossRef

23.

Saito Y, Omiya H, Kohno K, Kobayashi T, Itoi K, Teramachi M, et al. Pulmonary metastasectomy for 165 patients with colorectal carcinoma: A prognostic assessment. J Thorac Cardiovasc Surg. 2002;124(5):1007–13.PubMedCrossRef

24.

Shiono S, Ishii G, Nagai K, Yoshida J, Nishimura M, Murata Y, et al. Histopathologic prognostic factors in resected colorectal lung metastases. Ann Thorac Surg. 2005;79(1):278–82; discussion 283.PubMedCrossRef

25.

Vogelsang H, Haas S, Hierholzer C, Berger U, Siewert JR, Prauer H. Factors influencing survival after resection of pulmonary metastases from colorectal cancer. Br J Surg. 2004;91(8):1066–71.PubMedCrossRef

26.

Headrick JR, Miller DL, Nagorney DM, Allen MS, Deschamps C, Trastek VF, et al. Surgical treatment of hepatic and pulmonary metastases from colon cancer. Ann Thorac Surg. 2001;71(3):975–9; discussion 979–80.PubMedCrossRef

27.

Iizasa T, Suzuki M, Yoshida S, Motohashi S, Yasufuku K, Iyoda A, et al. Prediction of prognosis and surgical indications for pulmonary metastasectomy from colorectal cancer. Ann Thorac Surg. 2006;82(1):254–60.PubMedCrossRef

28.

Kanemitsu Y, Kato T, Hirai T, Yasui K. Preoperative probability model for predicting overall survival after resection of pulmonary metastases from colorectal cancer. Br J Surg. 2004;91(1):112–20.PubMedCrossRef

29.

Watanabe I, Arai T, Ono M, Sugito M, Kawashima K, Ito M, et al. Prognostic factors in resection of pulmonary metastasis from colorectal cancer. Br J Surg. 2003;90(11):1436–40.PubMedCrossRef

30.

Melloni G, Doglioni C, Bandiera A, Carretta A, Ciriaco P, Arrigoni G, et al. Prognostic factors and analysis of microsatellite instability in resected pulmonary metastases from colorectal carcinoma. Ann Thorac Surg. 2006;81(6):2008–13.PubMedCrossRef

31.

Ike H, Shimada H, Ohki S, Togo S, Yamaguchi S, Ichikawa Y. Results of aggressive resection of lung metastases from colorectal carcinoma detected by intensive follow-up. Dis Colon Rectum. 2002;45(4):468–73; discussion 473–5.PubMedCrossRef

32.

Moore KH, McCaughan BC. Surgical resection for pulmonary metastases from colorectal cancer. ANZ J Surg. 2001;71(3):143–6.PubMedCrossRef

33.

Welter S, Jacobs J, Krbek T, Poettgen C, Stamatis G. Prognostic impact of lymph node involvement in pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg. 2007;31(2):167–72.PubMedCrossRef

34.

Miller G, Biernacki P, Kemeny NE, Gonen M, Downey R, Jarnagin WR, et al. Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases. J Am Coll Surg. 2007;205(2):231–8.PubMedCrossRef

35.

Shah SA, Greig PD, Gallinger S, Cattral MS, Dixon E, Kim RD, et al. Factors associated with early recurrence after resection for hepatocellular carcinoma and outcomes. J Am Coll Surg. 2006;202(2):275–83.PubMedCrossRef

36.

Carpizo DR, Are C, Jarnagin WR, DeMatteo RP, Fong Y, Gonen M, et al. Liver resection for metastatic colorectal cancer in patients with concurrent extrahepatic disease: results in 127 patients treated at a single center. Ann Surg Oncol. 2008; In Press.

37.

Koppe MJ, Boerman OC, Oyen WJ, Bleichrodt RP. Peritoneal carcinomatosis of colorectal origin: incidence and current treatment strategies. Ann Surg. 2006;243(2):212–22.PubMedCrossRef

38.

Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21(20):3737–43.PubMedCrossRef

39.

Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15(9):2426–32.PubMedCrossRef

40.

Elias D, Dube P, Bonvalot S, Meshaka P, Manai M, Cavalcanti A, et al. Treatment of liver metastases with moderate peritoneal carcinomatosis by hepatectomy and cytoreductive surgery followed by immediate post-operative intraperitoneal chemotherapy: feasibility and preliminary results. Hepatogastroenterology. 1999;46(25):360–3.PubMed

41.

Elias D, Benizri E, Pocard M, Ducreux M, Boige V, Lasser P. Treatment of synchronous peritoneal carcinomatosis and liver metastases from colorectal cancer. Eur J Surg Oncol. 2006;32(6):632–6.PubMedCrossRef

42.

Elias DD, Ouellet JJF, Bellon NN, Pignon JJP, Pocard MM, Lasser PP. Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg. 2003;90(5):567–74.PubMedCrossRef

43.

Adson MA. Resection of liver metastases–when is it worthwhile? World J Surg. 1987;11(4):511–20.PubMedCrossRef

44.

Elias DD, Sideris LL, Pocard MM, Ouellet JFJ-F, Boige VV, Lasser PP, et al. Results of R0 resection for colorectal liver metastases associated with extrahepatic disease. Ann Surg Oncol. 2004;11(3):274–80.PubMedCrossRef

45.

Elias DD, Liberale GG, Vernerey DD, Pocard MM, Ducreux MM, Boige VV, et al. Hepatic and extrahepatic colorectal metastases: when resectable, their localization does not matter, but their total number has a prognostic effect. Ann Surg Oncol. 2005;12(11):900–9.PubMedCrossRef

46.

Strasberg SS. Re: Hepatic and extrahepatic colorectal metastases: when resectable, their localization does not matter, but their total number has a prognostic effect. Ann Surg Oncol. 2007;14(4):1517–8.PubMedCrossRef

47.

Fortner JG, Silva JS, Golbey RB, Cox EB, Maclean BJ. Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. I. Treatment by hepatic resection. Ann Surg. 1984;199(3):306–16.PubMedCrossRef

48.

Kobayashi K, Kawamura M, Ishihara T. Surgical treatment for both pulmonary and hepatic metastases from colorectal cancer. J Thorac Cardiovasc Surg. 1999; 118(6):1090–6.

49.

Nagakura S, Shirai Y, Yamato Y, Yokoyama N, Suda T, Hatakeyama K. Simultaneous detection of colorectal carcinoma liver and lung metastases does not warrant resection. J Am Coll Surg. 2001;193(2):153–60.

50.

Reddy RH, Kumar B, Shah R, Mirsadraee S, Papagiannopoulos K, Lodge P, et al. Staged pulmonary and hepatic metastasectomy in colorectal cancer--is it worth it? Eur J Cardiothorac Surg. 2004;25(2):151–4.

51.

Mineo TC, Ambrogi V, Tonini G, Bollero P, Roselli M, Mineo D, et al. Longterm results after resection of simultaneous and sequential lung and liver metastases from colorectal carcinoma. J Am Coll Surg. 2003;197(3):386–91.

Title: Liver Resection for Metastatic Colorectal Cancer in the Presence of Extrahepatic Disease
Authors: Darren R. Carpizo, MD, PhD
Michael D’Angelica, MD
Publication date: 01-09-2009
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 9/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-009-0493-6

At a glance: The STEP trials

Springer Medicine

Liver Resection for Metastatic Colorectal Cancer in the Presence of Extrahepatic Disease

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2009

Response to Letter to the Editor: Isolated Tumor Cells in Sentinel Lymph Nodes and Clinical Implications for Early Breast Cancer

Timing Means Everything, Maybe

The Impact of Obesity on Outcomes Following Pancreatectomy for Malignancy

Outcomes of Ablation Versus Resection for Colorectal Liver Metastases: Are We Comparing Apples with Oranges?

Is Endoscopic Papillectomy Safe for Ampullary Adenomas with High-Grade Dysplasia?

Synchronous Colorectal Liver Metastases: Is It Time to Reconsider Traditional Paradigms of Management?