scholarly journals Ten-Year Survival after Liver Resection for Colorectal Metastases: Systematic Review and Meta-Analysis

ISRN Oncology ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-11 ◽  
Author(s):  
Saleh Abbas ◽  
Vincent Lam ◽  
Michael Hollands
Keyword(s):  
Prognostic Factors ◽  
Liver Resection ◽  
Resection Margin ◽  
Meta Analysis ◽  
Colorectal Metastases ◽  
Resection Margins ◽  
Primary Disease ◽  
Clear Resection Margin ◽  
Node Involvement ◽  
Positive Resection Margins

Background. Liver resection in metastatic colorectal cancer is proved to result in five-year survival of 25–40%. Several factors have been investigated to look for prognostic factors stratifications such as resection margins, node involvement in the primary disease, and interval between the primary disease and liver metastases. Methods. We searched MEDLINE and EMBASE for studies that reported ten-year survival. Metaanalysis was performed to analyse the effect of recognised prognostic factors on cure rate for colorectal metastases. The meta-analysis was performed according to Ottawa-Newcastle method of analysis for nonrandomised trials and according to the guidelines of the PRISMA. Results. Eleven studies were included in the analysis, which showed a ten-year survival rate of 12–36%. Factors that have favourable impact are clear resection margin, low level of CEA, single metastatic deposit, and node negative disease. The only factor that excluded patients from cure is the positive status of the resection margin. Conclusion. Predicted ten-year survival after liver resection for colorectal metastases varies from 12 to 36%. Only positive resection margins resulted in no 10-year survivors. No patient can be excluded from consideration for liver resection so long the result is negative margins.

scholarly journals Management of colorectal polyp cancers

2012 ◽  
Vol 94 (8) ◽  
pp. 574-578 ◽  
Author(s):  
S Naqvi ◽  
S Burroughs ◽  
HS Chave ◽  
G Branagan
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Resection Margin ◽  
Adverse Outcome ◽  
Colorectal Polyps ◽  
Adverse Outcomes ◽  
Resection Margins ◽  
Residual Tumour ◽  
Clear Resection Margin ◽  
Node Metastases

INTRODUCTION Management of malignant colorectal polyps is controversial. The options are resection or surveillance. Resection margin status is accepted as an independent predictor of adverse outcome. However, the rate of adverse outcome in polyps with a resection margin of <1mm has not been investigated. METHODS A retrospective search of the pathology database was undertaken. All polyp cancers were included. A single histopathologist reviewed all of the included polyp cancers. Polyps were divided into three groups: clear resection margin, involved resection margin and unknown resection margin. Polyps were also analysed for tumour grade, morphology, Haggitt/Kikuchi level and lymphovascular invasion. Adverse outcome was defined as residual tumour at the polypectomy site and/or lymph node metastases in the surgical group and local or distant recurrence in the surveillance group. RESULTS Sixty-five polyps (34 male patients, mean age: 73 years, range: 50–94 years) were included. Forty-six had clear polyp resection margins; none had any adverse outcomes. Sixteen patients had involved polyp resection margins and twelve of these underwent surgery: seven had residual tumour and two of these patients had lymph node metastases. Four underwent surveillance, of whom two developed local recurrence. Three patients had resection margins on which the histopathologist was unable to comment. All patients with a clear resection margin had no adverse outcome regardless of other predictive factors. CONCLUSIONS Polyp cancers with clear resection margins, even those with <1mm clearance, can be treated safely with surveillance in our experience. Polyp cancers with unknown or involved resection margins should be treated surgically.

Liver Resection for Colorectal Metastases: Results and Prognostic Factors

2002 ◽  
pp. 33-41
Author(s):  
Val Usatoff ◽  
Paul Hansen ◽  
Dhia Al-Musawi ◽  
Roman Havlik ◽  
Caroline Dore ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Liver Resection ◽  
Colorectal Metastases

Clinical outcomes of positive resection margins after endoscopic resection of early colorectal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 688-688
Author(s):  
Jin-Oh Kim
Keyword(s):  
Cancer Cells ◽  
Clinical Outcomes ◽  
Cancer Cell ◽  
Endoscopic Resection ◽  
Resection Margin ◽  
Early Colorectal Cancer ◽  
Resection Margins ◽  
Positive Resection Margin ◽  
Positive Group ◽  
Positive Resection Margins

688 Background: The management of patients with a positive resection margin after endoscopic resection of early colorectal cancer (ECC) depends on various clinical factors, including the pathology. There is little information on the clinical outcomes according to the subsequent management of a positive resection margin in patients with ECC treated by endoscopic resection. We assessed the management according to the pathology of the positive margin and evaluated the clinical outcomes. Methods: Consecutive patients with ECC who underwent endoscopic resection from January 2004 to December 2014 were reviewed. This study retrospectively analyzed 363 lesions from 338 patients (mean age, 60.1 years; 68% [230/338] male). Results: The resection margin was positive in 29.2% of patients, including cancer cells in 9.9%, adenoma in 16.5%, and high-grade dysplasia (HGD) in 2.8%. Subsequent surgery was performed on 11.8% of patients, 72.2% (26/43) of whom were cancer cell–positive, while 23.3% (10/43) were resection margin–negative but had deep submucosal (SM) or lymphatic invasion. Remnant cancer cells were identified in 25.6% (11/43) of the operated group and 81.8% (9/11) of the cancer cell–positive group. On early follow-up surveillance colonoscopy (mean interval, 3.57 months) in 88.2% of patients (320/363), including 95.7% (67/70) of the adenoma and HGD-positive group, only one (0.3%, 1/320) case of remnant adenoma was found. In the multivariate analysis, deep SM invasion ( p=0.026), number of pieces of piecemeal resection (p=0.03) and cancer cell positivity ( p=0.001) predicted subsequent surgery. In the multivariate analysis, an endoscopic appearance of incomplete resection ( p=0.002) and cancer cell positivity (p=0.041) were related to the identification of remnant cancer cells after subsequent surgery. Conclusions: Patients with an adenoma-positive resection margin had favorable clinical outcomes during subsequent surveillance. The choice of subsequent surgery was related to deep SM invasion and cancer cell–positive resection margins, and subsequent surgery group showed a high rate of remnant cancer cells.

scholarly journals Systematic Review and Meta-Analysis of Liver Resection for Colorectal Metastases in Elderly Patients

2018 ◽  
Vol 36 (2) ◽  
pp. 111-123 ◽  
Author(s):  
Tim van Tuil ◽  
Ali A. Dhaif ◽  
Wouter W. te Riele ◽  
Bert van Ramshorst ◽  
Hjalmar C. van Santvoort
Keyword(s):  
Systematic Review ◽  
Liver Resection ◽  
Elderly Patients ◽  
Postoperative Morbidity ◽  
Meta Analysis ◽  
Colorectal Metastases ◽  
Cochrane Library ◽  
Long Term Outcomes ◽  
Short And Long Term

Background: This systematic review and meta-analysis evaluated the short- and long-term outcomes of liver resection for colorectal liver metastases (CRLM) in elderly patients. Methods: A PubMed, EMBASE, and Cochrane Library search was performed from January 1995 to April 2017, for studies comparing both short- and long-term outcomes in younger and elderly patients undergoing liver resection for CRLM. Results: Eleven studies comparing patients aged <70 years with patients aged >70 years and 4 studies comparing patients aged <75 years with patients aged >75 years were included. Postoperative morbidity was similar in patients aged >70 years (27 vs. 30%; p = 0.35) but higher in patients aged >75 years (21 vs. 32%; p = 0.001). Postoperative mortality was higher in both patients aged >70 years (2 vs. 4%; p = 0.01) and in patients aged >75 years (1 vs. 6%; p = 0.02). Mean 5-year overall survival was lower in patients aged >70 years (40 vs. 32%; p < 0.001) but equal in patients aged >75 years (42 vs. 32%; p = 0.06). Conclusion: Although postoperative morbidity and mortality were increased with higher age, liver resection for CRLM seems justified in selected elderly patients.

Prognostic significance of tumour budding, tumour–stroma ratio and desmoplastic stromal reaction in gall bladder carcinoma

2021 ◽  
pp. jclinpath-2021-207957
Author(s):  
Surbhi Goyal ◽  
Priyanka Banga ◽  
Nisha Meena ◽  
Geeta Chauhan ◽  
Puja Sakhuja ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
High Risk ◽  
Gall Bladder ◽  
Clinicopathological Parameters ◽  
Resection Margins ◽  
Tumour Stroma ◽  
Stromal Reaction ◽  
Positive Resection Margins ◽  
Desmoplastic Stromal Reaction ◽  
Tumour Budding

Aims and methodsThe prognostic role of tumour budding (TBd) and its interaction with the stromal microenvironment has gained a lot of attention recently, but remains unexplored in gall bladder cancer (GBC). We aimed to study the interrelationship of TBd by International Tumour Budding Consensus Conference scoring system, tumour–stroma ratio (TSR) and desmoplastic stromal reaction (DSR) with the conventional clinicopathological prognostic factors, mortality and overall survival (OS) in 96 patients of operated GBC.ResultsHigher age, high TNM stage, lymphovascular and perineural invasion, positive resection margins, higher TBd score, low TSR and immature DSR were significantly associated with worse OS. However, on multivariate analysis, only metastases, positive resection margins and TSR <50% proved to be independent prognostic factors. The TBd score of stroma-rich tumour group (6.40±4.69) was significantly higher than that of stroma-poor group (2.77±3.79, p≤0.001). The TBd score of immature and intermediate DSR groups was significantly higher than that of mature group (p≤0.001 and p=0.002, respectively). There was a strong interobserver agreement for TBd score, TSR and type of DSR (Cohen’s Kappa=0.726 to 0.864, p≤0.001). Stroma-rich tumours were significantly associated with immature DSR and fibrotic DSR with high TSR (p≤0.001).ConclusionA high TBd, low TSR and immature DSR were significantly associated with several high-risk clinicopathological parameters and poor OS in GBC. These novel, simple, reproducible and cost-effective parameters may be included in the routine reporting checklist for GBC as additional prognostic parameters that can substratify the high-risk patients.

Radiotherapy for intrahepatic cholangiocarcinoma: An analysis of the National Cancer Database.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 379-379
Author(s):  
Abdulrahman Y Hammad ◽  
George Younan ◽  
Rahul Rajeev ◽  
Nicholas Gerard Berger ◽  
Kiran Turaga ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Intrahepatic Cholangiocarcinoma ◽  
Resection Margin ◽  
Early Stage ◽  
Disease Stage ◽  
Resection Margins ◽  
National Cancer Database ◽  
Kaplan Meier ◽  
Positive Resection Margins ◽  
The Impact

379 Background: The role of radiotherapy (RT) for surgically resected intrahepatic cholangiocarcinoma (ICC) remains poorly defined. Radiotherapy is often considered when a positive resection margin exists. The present study sought to examine the impact of radiotherapy following liver resection. Methods: Patients with early stage ICC, who underwent surgical resection, were identified from the National Cancer Database (1998-2011). Patients were stratified by resection margin status and receipt of RT. Survival was analyzed by Kaplan-Meier method and a multivariate regression model was used to identify predictors of survival. Results: A total of 2,182 patients were identified. R0 status was obtained in 1,624 patients (74.4%). RT was delivered to 405 patients (R0=209, R1/R2=196). In the R1/R2 group, 196 patients received RT vs. 362 R1/R2 patients that did not receive RT. Survival for R0 vs. R1/R2 was 32m vs. 16.5m (p<0.001). RT appeared to trend toward improving survival for R1/R2 patients, though this was not significant (20.4m vs. 14.5m, p=0.191). In a multivariate model accounting for age, sex, comorbidities, disease stage and resection margins, RT was not a predictor of survival. Negative predictors of survival included age>65years (Hazards Ratio [HR]: 1.20 (95%CI: 1.04-1.39), p=0.013), and positive resection margins (HR: 1.95 (95%CI: 1.65-2.30), p<0.001). Female sex was the only positive predictor of survival identified (HR: 0.76 (95%CI: 0.65 -0.88), p<0.001). Conclusions: Surgical resection with negative margins provides the best outcome for patients with ICC. Radiotherapy does not appear to significantly impact survival in patients with positive resection margins.

Outcomes and prognostic factors of localized, resected malignant salivary gland tumors: Examining a single institution’s 12-year experience to discover indications for adjuvant chemotherapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17587-e17587
Author(s):  
Tyler Gutschenritter ◽  
Michael Machiorlatti ◽  
Sara Vesely ◽  
Bilal Ahmad ◽  
Wajeeha Razaq ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Prognostic Factors ◽  
Perineural Invasion ◽  
Smoking History ◽  
Adjuvant Chemoradiotherapy ◽  
Resection Margins ◽  
Survival Outcomes ◽  
Positive Resection Margins ◽  
Male Sex

e17587 Background: Survival outcomes remain poor in salivary gland malignancies (SGMs) with multiple poor prognostic factors despite adjuvant radiotherapy. We examined prognostic factors that portended poor survival in resected SGMs to determine possible indications for adjuvant chemoradiotherapy. Methods:Patients who underwent curative resection with or without adjuvant radiotherapy between 2002 and 2014 were identified and retrospective chart review was performed. Bivariate analysis was performed on continuous variables using Analysis of Variance. Chi-Square analysis and Fishers Exact Tests were performed on categorical variables. To evaluate the overall survival (OS) and disease-free survival (DFS), Kaplan-Meier curves and log-rank tests of homogeneity were used. Results: Overall, 99 patients met inclusion criteria. Median follow-up time was 46.8 months. Univariate analysis revealed male sex, smoking history ≥ 10 pack-years, high grade, stage III-IVB, squamous cell histology, and perineural invasion significantly impacted OS and DFS. High-risk histopathology significantly impacted DFS and trended towards poor OS. Positive resection margins trended towards significantly impacting DFS. Multivariate analysis revealed only male sex and perineural invasion significantly impacted OS and DFS. Conclusions: Survival outcomes remain poor for patients with high-grade, late-stage tumors with perineural invasion. Specifically, perineural invasion is a poor prognostic factor regardless of age, histology, stage, and grade. Males and patients with a smoking history ≥ 10 pack-years have worse survival outcomes with male sex being a more influential prognostic factor. Notably, this is the first study to quantify patient’s smoking history in malignant salivary gland tumors and assess the impact of pack-year smoking history on survival outcomes. Given our observed trend, positive resection margins would likely become significant influencer of DFS with larger sample size and longer follow up. Adjuvant chemoradiotherapy should be evaluated in patients with the above-mentioned characteristics.

Prognostic factors in patients with nonmetastatic gastric cancer treated with contemporary multimodality strategies.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 451-451
Author(s):  
Ariceli Alfaro ◽  
Tuyen Hoang ◽  
Jasmine Huynh ◽  
Jingran Ji ◽  
Andrew H. Ko ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Cox Regression ◽  
Cancer Recurrence ◽  
High Volume ◽  
Multimodality Therapy ◽  
Resection Margins ◽  
Study Cohort ◽  
Curative Intent ◽  
California Cancer Registry ◽  
Positive Resection Margins

451 Background: We conducted a retrospective study to evaluate clinical outcomes in patients with non-metastatic gastric adenocarcinoma (nmGA) treated at two high-volume academic institutions within the University of California (UC) system. Methods: Electronic Health Records and California Cancer Registry of demographic and clinical data were collected for pts with nmGA who underwent surgery with curative intent from 2010-2017. Medical chart reviews were conducted to validate outcomes. We used multivariate Cox regression to determine prognostic factors for cancer recurrence and overall survival. Results: Demographics of study cohort (n = 406): mean age 65 years; 71% male; 58% Caucasian, 26% Asian, 13% Latino. There was an even distribution between pts with locoregionally advanced (defined as pT4 or pN1+) vs. localized (pT1-3, pN0) disease. Tumor histology: 49% intestinal, 19% diffuse, 13% mixed, 19% unknown. Type of surgery: 27% open gastrectomy, 59% laparoscopic, 14% unknown. Multimodality therapy: 29% received perioperative systemic rx alone (48% adjuvant only, 52% neoadjuvant +/- adjuvant), 35% received perioperative systemic rx plus radiation (40% adjuvant only, 60% neoadjuvant +/- adjuvant), 36% underwent surgery only. With median f/u time after surgery of 5 years, 21% of pts developed cancer recurrence and 43% had died. Weight loss prior to diagnosis, locoregional stage, and positive resection margins were a/w recurrence (HR = 1.6-2.5, p < .05). Only locoregional stage was prognostic for worse survival (HR = 2.7, p < .0001). Positive resection margins were seen in 6% of pts and were a/w diffuse histology and tumor size > 4cm (odds ratio = 2.9-8.8, p < .02). Multimodality therapy was not a/w recurrence but was a/w longer survival after adjusting for stage (HR = 0.3, p < .0001). Addition of radiation to systemic rx did not confer further improvements in either recurrence or survival. Conclusions: This study highlights contemporary practice patterns for pts with nmGA and demonstrates a survival benefit with multimodality rx. Additional data are being gathered from other UC medical centers to confirm these findings and explore differences across institutions and ethnicities.

Sign in / Sign up

Export Citation Format

Share Document