À propos de l’article «Reappraisal of the risks and benefits of major liver resection in patients with initially unresectable colorectal liver metastases»

2013 ◽  
Vol 100 (9) ◽  
pp. 797
Author(s):  
Serge Evrard
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Major Liver Resection ◽  
Risks And Benefits ◽  
Unresectable Colorectal Liver Metastases

Reappraisal of the Risks and Benefits of Major Liver Resection in Patients With Initially Unresectable Colorectal Liver Metastases

2012 ◽  
Vol 256 (5) ◽  
pp. 746-754 ◽  
Author(s):  
François Cauchy ◽  
Béatrice Aussilhou ◽  
Safi Dokmak ◽  
David Fuks ◽  
Sébastien Gaujoux ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Major Liver Resection ◽  
Risks And Benefits ◽  
Unresectable Colorectal Liver Metastases

Major Hepatectomy for Colorectal Metastases in the Elderly: A Tertiary Center Experience

2015 ◽  
Vol 100 (9-10) ◽  
pp. 1276-1280
Author(s):  
Osama Damrah ◽  
Panagis M. Lykoudis ◽  
Rafael Orti-Rodriguez ◽  
Theodora Pissanou ◽  
Dinesh Sharma ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Elderly Patients ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Major Hepatectomy ◽  
Major Liver Resection ◽  
Primary Tumor Site ◽  
Group A

The purpose of this retrospective study was to investigate whether patients over 70 years old are at significantly higher risk for worse outcomes following major liver resection. Hepatic resection is the only treatment offering long-term survival for patients with colorectal liver metastases. As the population considered for metastasectomy is aging, there are still controversial published results regarding the safety of major hepatectomy in elderly patients. Between December 2002 and April 2010, 327 patients underwent major liver resection for colorectal liver metastasis. Patients were stratified into 2 groups: group A, <70 years old; and group B, ≥70 years old. Recorded, analyzed, and compared data across groups included the following: (1) patient characteristics including age, sex, American Society of Anesthesiologists performance status, primary tumor site and stage, adjuvant chemotherapy, number and size of metastatic lesions; (2) perioperative data including extent of resection, in-hospital mortality, postoperative morbidity, length of hospital stay, length of intensive treatment unit stay and blood loss; and (3) overall survival. The patients' characteristics were similar as were the characteristics of their tumors. There was no difference in overall morbidity (25% versus 22%) or postoperative mortality (2.6% versus 2.9%) (P = 0.44 and 0.57, respectively). The overall survival was 67% versus 62% in group A and B, respectively (P = 0.09). Elderly patients can safely undergo major liver resection for colorectal liver metastases with short- and long-term outcomes comparable with younger patients.

Does conversion chemotherapy really improve survival in patients with colorectal liver metastases?

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 435-435
Author(s):  
Kozo Kataoka ◽  
Akiyoshi Kanazawa ◽  
Shigeyoshi Iwamoto ◽  
Yasuhiro Miyake ◽  
Takeshi Kato ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Hepatic Resection ◽  
Colorectal Liver Metastases ◽  
Liver Volume ◽  
Hepatic Metastases ◽  
Disease Free Survival ◽  
R0 Resection ◽  
Remnant Liver ◽  
Unresectable Colorectal Liver Metastases

435 Background: Recently, liver resection becomes possible by intensive chemotherapy, i.e. conversion chemotherapy, in patients with initially unresectable colorectal liver metastases (CLM). But the criteria for non-resectability varies one team to another, and there are few reports about the clinical benefit of conversion chemotherapy followed by liver resection. Methods: Our criteria for resectability of CLM depends on the size of remnant liver volume (>30%) and expected function after the removal of all metastases, regardress of number and size of CLM. From December 2007 to September 2011, 113 patients were diagnosed as CLM without extra-hepatic metastases and received chemotherapy. 47 patients were initially diagnosed as resectable and received hepatic resection after chemotherapy (resected group). 66 patients were initially diagnosed as unresectable, but 11 patients become resectable after chemotherapy (conversion group) and 55 patients remain unresectable in spite of chemotherapy (unresecetd group). We assessed the survival benefit between these 3 groups, retrospectively. Results: 110 patients received oxaliplatin-based regimen and 3 irrinotecan-based regimen. In coversion group, 8 patients received cetuximab containing regimen and 2 received bevacizumab containing regimen. 46 of 47 patients in resected group received R0 resection and 7 of 11 patients in conversion group. No serious postoperative complications were observed in resected and conversion group, but the incidence of a surgical site infection in conversion group was somewhat higher than in resected group. Median disease-free survival was significantly higher in the resected group than conversion group (16.73 months [95% CI: 7.80~25.47] and 3.83 months [95% CI: 0.35~7.31 months]) (P=0.031). And median overall survival (OS) was also higher in resected group, but not significant. In resected and conversion group, median OS was significantly higher than in unresected group. (52.20 vs 39.37 vs 20.57 months (p <0.001)). Conclusions: The recurrence rate was higher in coversion group, but conversion chemotherapy followed by hepatic resection seems to be promising and feasible strategy in initially unresectable CLM patients.

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.

CD133 + cell infusion in patients with colorectal liver metastases going to be submitted to a major liver resection (CELLCOL): A randomized open label clinical trial

2020 ◽  
Vol 33 ◽  
pp. 224-230
Author(s):  
Alejandra Garcia-Botella ◽  
Patricia Sáez-Carlin ◽  
Ramiro Méndez ◽  
Maria Paz Martin ◽  
Luis Ortega ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Major Liver Resection ◽  
Open Label

scholarly journals Radiofrequency ablation of unresectable colorectal liver metastases: trends in management and outcome during a decade at a single center

2015 ◽  
Vol 4 (7) ◽  
pp. 205846011558087 ◽  
Author(s):  
Knut Jørgen Labori ◽  
Anselm Schulz ◽  
Anders Drolsum ◽  
Marianne Grønlie Guren ◽  
Nils Einar Kløw ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Local Recurrence ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Surgical Techniques ◽  
Hepatic Veins ◽  
Time Period ◽  
Unresectable Colorectal Liver Metastases ◽  
Portal Veins

Background Radiofrequency ablation (RFA) is widely used for treatment of colorectal liver metastases (CRLM). Purpose To evaluate the effect of increased experience in RFA of CRLM on morbidity and survival, and the trends in patient management and outcomes during the last decade. Material and Methods Hospital records of the initial 52 consecutive patients who underwent RFA (56 procedures/70 lesions) were retrospectively reviewed. The patients were divided into two groups according to time period of treatment, period I (2001–2006: n = 26) and period II (2007–2011: n = 26). Results Concomitant liver resection was performed in 15 patients in each period. Operative morbidity decreased from 47% to 19% ( P = 0.047). Most complications were found in patients who underwent a concomitant liver resection and not related to the ablation per se. Local recurrence rate decreased from 19.4% to 12.9% ( P = 0.526). At least one risk factor for recurrence was found in patients with local recurrence ( n = 11): subcapsular localization ( n = 4), tumor size >3 cm and subcapsular localization ( n = 2), and perivascular localization (portal veins/hepatic veins) ( n = 5). Median overall survival was 32 months in period I and 49 months in period II, whereas estimated 5-year survival was 19% and 36%, respectively ( P = 0.09). Adjuvant chemotherapy was given to four patients (15.4%) in period I and 13 patients (50%) in period II ( P = 0.017). Conclusion RFA alone or in combination with liver resection is a potentially curative treatment to selected patients with CRLM. Over time, the morbidity and survival have improved in RFA of CRLM. Although a possible effect of a learning curve should be taken into consideration in the appraisal of this improvement, it is more likely to be attributable to optimization of indication, development in surgical techniques, and increased use of perioperative chemotherapy.

Outcomes of Simultaneous Major Liver Resection and Colorectal Surgery for Colorectal Liver Metastases

2015 ◽  
Vol 20 (3) ◽  
pp. 554-563 ◽  
Author(s):  
Paramin Muangkaew ◽  
Jai Young Cho ◽  
Ho-Seong Han ◽  
Yoo-Seok Yoon ◽  
YoungRok Choi ◽  
...  
Keyword(s):  
Liver Resection ◽  
Colorectal Surgery ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Major Liver Resection
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