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23-10-2024 | Metastasis | ASO Author Reflections

ASO Author Reflections: Biological Contraindications to Surgery in Colorectal Liver Metastasis

Authors: Kazunari Sasaki, MD, Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FSSO, FRACS (Hon), Georgios Antonios Margonis, MD, PhD

Published in: Annals of Surgical Oncology

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Excerpt

The resectability of colorectal liver metastases (CRLM) is typically categorized as ‘resectable’, ‘borderline’, or ‘unresectable’. The proportion of cases classified as ‘unresectable’ has decreased over the years, as resectable disease is now defined as any tumor burden, provided the liver remnant is sufficient to maintain adequate liver function. Conversely, the proportion of cases deemed ‘borderline’ has increased, as certain patient- and tumor-related characteristics that previously defined ‘unresectable’ cases (e.g., extrahepatic disease or tumor number) are now used to classify ‘borderline’ disease. The rationale is that these characteristics reflect aggressive tumor biology, and the combinations of these factors have been employed to devise clinical risk scores, such as the Fong score, aimed at guiding resectability decisions. As early as 1999, Fong and colleagues noted that information on tumor biology “may further stratify patients with regard to outcome”, provided “it becomes routinely available beyond a few academic centers”.1 Over the last decade, RAS mutations, and to a lesser extent BRAF mutations, have been commonly tested for clinical purposes. These mutations, along with clinicopathologic variables, have been used to develop clinico-biological risk scores that hold promise to identify ‘biological contraindications’ for CRLM resection. However, to our knowledge, these proposed ‘biological contraindications’ have not been validated outside the cohorts/studies used to devise them, leaving it unclear whether they can be applied in clinical practice. …
Literature
1.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
3.
go back to reference Passot G, Denbo JW, Yamashita S, et al. Is hepatectomy justified for patients with RAS mutant colorectal liver metastases? An analysis of 524 patients undergoing curative liver resection. Surgery. 2017;161(2):332–40.CrossRefPubMed Passot G, Denbo JW, Yamashita S, et al. Is hepatectomy justified for patients with RAS mutant colorectal liver metastases? An analysis of 524 patients undergoing curative liver resection. Surgery. 2017;161(2):332–40.CrossRefPubMed
4.
go back to reference Margonis GA, Sasaki K, Gholami S, et al. Genetic And Morphological Evaluation (GAME) score for patients with colorectal liver metastases. Br J Surg. 2018;105(9):1210–20.CrossRefPubMed Margonis GA, Sasaki K, Gholami S, et al. Genetic And Morphological Evaluation (GAME) score for patients with colorectal liver metastases. Br J Surg. 2018;105(9):1210–20.CrossRefPubMed
5.
go back to reference Brudvik KW, Jones RP, Giuliante F, et al. RAS mutation clinical risk score to predict survival after resection of colorectal liver metastases. Ann Surg. 2019;269(1):120–6.CrossRefPubMed Brudvik KW, Jones RP, Giuliante F, et al. RAS mutation clinical risk score to predict survival after resection of colorectal liver metastases. Ann Surg. 2019;269(1):120–6.CrossRefPubMed
6.
go back to reference Gagniere J, Dupre A, Gholami SS, et al. Is hepatectomy justified for BRAF mutant colorectal liver metastases? A multi-institutional analysis of 1497 patients. Ann Surg. 2020;271(1):147–54.CrossRefPubMed Gagniere J, Dupre A, Gholami SS, et al. Is hepatectomy justified for BRAF mutant colorectal liver metastases? A multi-institutional analysis of 1497 patients. Ann Surg. 2020;271(1):147–54.CrossRefPubMed
Metadata
Title
ASO Author Reflections: Biological Contraindications to Surgery in Colorectal Liver Metastasis
Authors
Kazunari Sasaki, MD
Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FSSO, FRACS (Hon)
Georgios Antonios Margonis, MD, PhD
Publication date
23-10-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-16412-4
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