scholarly journals Surgical Options for Initially Unresectable Colorectal Liver Metastases

HPB Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
Irinel Popescu ◽  
Sorin Tiberiu Alexandrescu
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Palliative Treatment ◽  
Survival Rates ◽  
Portal Vein Ligation ◽  
Term Survival ◽  
Number Of Patients ◽  
Unresectable Colorectal Liver Metastases ◽  
Surgical Options

Although the frontiers of liver resection for colorectal liver metastases have broadened in recent decades, approximately 75% of these patients present with unresectable metastases at the time of their diagnosis. In the past, these patients underwent only palliative treatment, without the chance of a cure. In the previous two decades, several therapeutic strategies have been developed that render resectable those metastases that were initially unresectable, thus offering the chance of long-term survival and even a cure to these patients. The oncosurgical modalities that are available include liver resection following portal vein ligation/embolization, “two-stage” liver resection, one-stage ultrasonically guided liver resection, hepatectomy following conversion chemotherapy, and liver resection combined with thermal ablation. Moreover, in recent years, certain authors have recommended the revisiting of the concept of liver transplantation in highly selected patients with unresectable colorectal liver metastases and favorable prognostic factors. By employing such therapies, the number of patients with colorectal liver metastases who undergo a potentially curative treatment could increase to 40%. The safety profile of these approaches is acceptable (morbidity rates as high as 45%, mortality rates of less than 5%). Furthermore, the 5-year survival rates (approximately 30%) are significantly increased over those that were achieved with palliative treatment.

Radiofrequency ablation of colorectal liver metastases

2019 ◽  
Vol 98 (10) ◽  
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Postoperative Mortality ◽  
Disease Free Survival ◽  
Female Ratio ◽  
Liver Resections ◽  
Multi Stage

Introduction: Radical liver resection is the only method for the treatment of patients with colorectal liver metastases (CLM); however, only 20–30% of patients with CLMs can be radically treated. Radiofrequency ablation (RFA) is one of the possible methods of palliative treatment in such patients. Methods: RFA was performed in 381 patients with CLMs between 01 Jan 2001 and 31 Dec 2018. The mean age of the patients was 65.2±8.7 years. The male to female ratio was 2:1. Open laparotomy was done in 238 (62.5%) patients and the CT-navigated transcutaneous approach was used in 143 (37.5%) patients. CLMs <5 cm (usually <3 cm) in diameter were the indication for RFA. We used RFA as the only method in 334 (87.6%) patients; RFA in combination with resection was used in 36 (9.4%), and with multi-stage resection in 11 (3%) patients. We performed RFA in a solitary CLM in 170 (44.6%) patients, and in 2−5 CLMs in 211 (55.6%) patients. We performed computed tomography in each patient 48 hours after procedure. Results: The 30-day postoperative mortality was zero. Complications were present in 4.8% of transcutaneous and in 14.2% of open procedures, respectively, in the 30-day postoperative period. One-, 3-, 5- and 10-year overall survival rates were 94.8, 66.8, 43.9 and 16.6%, respectively, in patients undergoing RFA, and 90.6, 69.1, 52.8 and 39.2%, respectively, in patients with liver resections. Disease free survival was 63.2, 30.1, 18.4 and 13.1%, respectively, in the same patients after RFA, and 71.1, 33.3, 22.8 and 15.5%, respectively, after liver resections. Conclusion: RFA is a palliative thermal ablation method, which is one of therapeutic options in patients with radically non-resectable CLMs. RFA is useful especially in a non-resectable, or resectable (but for the price of large liver resection) solitary CLM <3 cm in diameter and in CLM relapses. RFA is also part of multi-stage liver procedures.

scholarly journals P-166 Re-hepatectomy is a predictor of long-term survival in patients that recur after liver resection of colorectal liver metastases

2016 ◽  
Vol 27 ◽  
pp. ii49
Author(s):  
M. Marques ◽  
H.S. de Castro Ribeiro ◽  
W.L. Costa ◽  
A.L. Diniz ◽  
A. Godoy ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Term Survival ◽  
Long Term Survival

Nonresponse to pre-operative chemotherapy does not preclude long-term survival after liver resection in patients with colorectal liver metastases

Surgery ◽  
2009 ◽  
Vol 146 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Ulf P. Neumann ◽  
Armin Thelen ◽  
Christoph Röcken ◽  
Daniel Seehofer ◽  
Marcus Bahra ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Term Survival ◽  
Long Term Survival

Impact of preoperative chemotherapy on overall survival for borderline resectable colorectal liver metastases

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 365-365
Author(s):  
Akio Saiura ◽  
Yosuke Inoue ◽  
Yoshihiro Mise ◽  
Yu Takahashi ◽  
Takafumi Ichida ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Liver Metastases ◽  
Preoperative Chemotherapy ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Controlled Study ◽  
Free Survival ◽  
Surgical Failure ◽  
The Impact

365 Background: Treatment for borderline colorectal liver metastases (CLM) is often started with chemotherapy. However, the impact on overall survival (OS) is still unknown. Aims: The aim of this study is to analyze the impact of preoperative chemotherapy on the outcome for up-front resectable borderline CLMs (BLR-CLM). Methods: A retrospective review was performed of 169 patients who underwent liver resection of BLR-CLM among 510 patients underwent liver resection for CLM between 2005 and 2013. BLR-CRLM was defined as CRLM of four or more nodules or 5cm or larger nodule. Time to surgical failure (TSF) was defined as the time until unresectable relapse or death. OS, recurrence free survival (RFS) and TSF were compared between BLR-CLM treated with neoadjuvant chemotherapy (NAC) and up-front surgery (US). Results: After median follow-up period of 38 months, 5-year survival rate after liver resection of resectable cases (n = 263), BLR-CLM (n = 169), and initially unresectable CLM (n = 78) are 67.7%, 47.5% and 32.6%, respectively. For patients with BLR-CLM, 22 patients with early recurrence during or early after postoperative chemotherapy for the primary were excluded. In the remaining 147 patients, 75 patients were treated with NAC and 72 with US. Cumulative 5-year overall survival rates, progression free survival rates, and time-to surgical failure in NAC and US group are as follows: OS (60.1% vs 47.7%, p = 0.084), PFS (23.1% vs 15.5%, p < 0.0001), TSF (38.0% vs 34.4%, p = 0.020). Conclusions: Preoperative chemotherapy for BLR-CLM could improve PFS and TSF. The impact on OS was still marginal. Prospective controlled study will be necessary.

scholarly journals SIMULTANEOUS AND STAGED RESECTIONS FOR SYNCHRONOUS COLORECTAL LIVER METASTASES: META-ANALYSIS

2017 ◽  
pp. 6-21 ◽  
Author(s):  
A. A. Ponomarenko ◽  
Yu. A. Shelygin ◽  
E. G. Rybakov ◽  
S. I. Achkasov
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Meta Analysis ◽  
Survival Rates ◽  
Mortality Rates ◽  
Synchronous Colorectal Liver Metastases ◽  
Overall Survival Rates

AIM. To analyze the short-term and long-term outcomes two alternative surgical strategies: 1) simultaneous resections for colorectal cancer and synchronous colorectal liver metastases;2) conventional surgery for the primary tumor during the initial operation. After time, the liver resection is performed at a second operation METHODS. Meta-analysis was performed to compare outcomes simultaneous resections for colorectal cancer and synchronous colorectal liver metastases and staged surgery. Tumor localization, spread and number of metastasis, extent of operation, blood loss, length of hospital stay, postop mortality, complication rates, overall survival rates were analyzed. RESULTS. Twenty-nine studies with 5518 patients were included in meta-analysis. Multiple (р=0,007) and bilobed (р=0,0004) metastasis were more often in patients in group ofstaged resections. Major hepatectomy was also performed more often in group of staged resections. There were no significant differences in blood loss and postopirative mortality rates (p>0,05). Complication rate in group of simultaneous resections was lower than in group of staged resections (0R=0,8, 95 %CI: 0,7-1.0, p=0,048). 3- and 5-year overall survival rates were similar in both groups: 54% vs 55 %, and 37% vs 38%, respectively (р=0,007). CONCLUSION. Simultaneous resection of the primary tumor and the minor liver resection or extended hepatectomy in selected patients didn’t adversely affect on complications and mortality rates in equivalent long-term survival compared to staged liver resection. An important limitation of the present study is the bias and heterogeneity in compared groups due to retrospective data over the 20-year period.

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