Optimizing unresectable colorectal liver metastases for surgery--no limits, any benefits?

Comprehensive intervention to promote recovery of gastrointestinal function in patients after hepatobiliary surgery

AIM: To assess the clinical effects of comprehensive intervention in promoting the recovery of gastrointestinal function in patients after hepatobiliary surgery.

METHODS: Eighty-four patients after hepatobiliary surgery were randomly divided into either a study group (42 cases) or a control group (42 cases). The study group was treated by early enteral nutrition, domperidone, and Chinese medicine enema, and the control group was treated by fluid infusion and nutrition support. The times to recovery bowel sounds, first meal, anus exhaust, and defecation, serum albumin (SAlb), prealbumin (PA), prognostic nutritional index (PNI), as well as the rate of gallbladder fossa and subhepatic fluid formation on day 6 were compared for the two groups.

RESULTS: The times to recovery bowel sounds, firs meal, anus exhaust, and defecation for the study group were significantly lower than those for the control group (29.85 h ± 8.85 h vs 32.67 h ± 9.67 h, 30.01 h ± 6.78 h vs 35.14 h ± 10.83 h, 40.95 h ± 7.85 h vs 49.84 h ± 15.79 h, 41.35 h ± 12.56 h vs 53.86 h ± 1.35 h, P < 0.05). The levels of SAlb, PA, and PNI for the study group post treatment were significantly higher than the values prior treatment (40.85 g/L ± 3.85 g/L vs 35.83 g/L ± 2.84 g/L, 4.00 g/dL ± 1.35 g/dL vs 2.85 g/dL ± 0.75 g/dL, 46.88 ± 5.78 vs 42.15 ± 8.83, P < 0.05), and than those for the control group (40.85 g/L ± 3.85 g/L vs 33.32 g/L ± 2.45 g/L, 4.00 g/dL ± 1.35 g/dL vs 1.85 g/dL ± 0.71 g/dL, 46.88 ± 5.78 vs 40.81 ± 5.76, P < 0.05). The rate of no gallbladder fossa and subhepatic fluid formation on day 6 for the study group was significantly higher than that for the control group (69.05% vs 40.48%, P < 0.05). The rates of fluid formation with a diameter < 2 cm and a diameter > 2 cm for the study group were significantly lower than those for the control group (9.52% vs 26.19%, 21.43% vs 33.33%, P < 0.05).

CONCLUSION: Comprehensive intervention by early enteral nutrition, domperidone, and Chinese medicine enema can shorten the time to gastrointestinal functional recovery and reduce the occurrence of gallbladder fossa and subhepatic fluid formation in patients after hepatobiliary surgery.

Liver-directed therapies in metastatic colorectal cancer

Colorectal cancer (CRC) is a major health concern in the United States (US) with over 140,000 new cases diagnosed in 2012. The most common site for CRC metastases is the liver. Hepatic resection is the treatment of choice for colorectal liver metastases (CLM), with a 5-year survival rate ranging from 35% to 58%. Unfortunately, only about 20% of patients are eligible for resection. There are a number of options for extending resection to more advanced patients including systemic chemotherapy, portal vein embolization (PVE), two stage hepatectomy, ablation and hepatic artery infusion (HAI). There are few phase III trials comparing these treatment modalities, and choosing the right treatment is patient dependent. Treating hepatic metastases requires a multidisciplinary approach and knowledge of all treatment options as there continues to be advances in management of CLM. If a patient can undergo a treatment modality in order to increase their potential for future resection this should be the primary goal. If the patient is still deemed unresectable then treatments that lengthen disease-free and overall-survival should be pursued. These include chemotherapy, ablation, HAI, chemoembolization, radioembolization (RE) and stereotactic radiotherapy.