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Yamada S, Motegi H, Kurihara Y, Shimbo T, Kikuchi I, Wakabayashi T, Sato T. A resected case of acinar cell carcinoma of the pancreas with liver metastasis following chemotherapy using modified FOLFIRINOX. Surg Case Rep 2023; 9:147. [PMID: 37610633 PMCID: PMC10447704 DOI: 10.1186/s40792-023-01729-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Acinar cell carcinoma of the pancreas is a rare exocrine malignancy representing less than 1% of all pancreatic neoplasms. It has been reported that it responds to treatment differently from pancreatic ductal adenocarcinoma and the treatment algorithm for acinar cell carcinoma usually depends on the stage of the respective tumor and the patient's current status. CASE PRESENTATION A 60-year-old man presented with upper abdominal pain and anorexia. Abdominal ultrasonography showed a large-sized hepatic mass and he was referred to our hospital. Contrast-enhanced computed tomography demonstrated a 110-mm low-density area occupying the right hemi-liver and an enhanced mass of 70 × 56 mm in the tail of the pancreas, which seemed to directly infiltrate into the spleen. The case was diagnosed as acinar cell carcinoma with a simultaneous liver metastasis identified by liver biopsy. Upfront resection of pancreatic cancer with distant metastasis might not be considered as an optimal choice, and in this case chemotherapy was administered prior to curative resection. Chemotherapy using the modified FOLFIRINOX regimen was undertaken, resulting in a partial remission; the liver tumor reduced in size from 110 to 47 mm and the pancreatic tumor from 70 to 40 mm. The patient then safely underwent curative hepatic resection with distal pancreato-splenectomy. Histological examinations revealed small-sized atypical cells with large nuclei that had formed acinar patterns, and immunostaining with trypsin was positive in tumor cells, which was in accordance with acinar cell carcinoma. More than 3 years later, the patient is doing well without any recurrence. CONCLUSION Aggressive and curative surgery in combination with chemotherapy such as FOLFIRINOX could be a treatment option to achieve long-term survival in cases of acinar cell carcinoma with liver metastases.
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Affiliation(s)
- Shuhei Yamada
- Department of Gastroenterological Surgery, Akita City Hospital, 4-30 Kawamoto Matsuoka-machi, Akita-city, Akita, Japan.
| | - Haruka Motegi
- Department of Gastroenterological Surgery, Akita City Hospital, 4-30 Kawamoto Matsuoka-machi, Akita-city, Akita, Japan
| | - Yoshiki Kurihara
- Department of Gastroenterological Surgery, Akita City Hospital, 4-30 Kawamoto Matsuoka-machi, Akita-city, Akita, Japan
| | - Tomonori Shimbo
- Department of Gastroenterological Surgery, Akita City Hospital, 4-30 Kawamoto Matsuoka-machi, Akita-city, Akita, Japan
| | - Isao Kikuchi
- Department of Gastroenterological Surgery, Akita City Hospital, 4-30 Kawamoto Matsuoka-machi, Akita-city, Akita, Japan
| | - Toshiki Wakabayashi
- Department of Gastroenterological Surgery, Akita City Hospital, 4-30 Kawamoto Matsuoka-machi, Akita-city, Akita, Japan
| | - Tsutomu Sato
- Department of Gastroenterological Surgery, Akita City Hospital, 4-30 Kawamoto Matsuoka-machi, Akita-city, Akita, Japan
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2
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Peloso A, Tihy M, Moeckli B, Rubbia-Brandt L, Toso C. Clearing Steatosis Prior to Liver Surgery for Colorectal Metastasis: A Narrative Review and Case Illustration. Nutrients 2022; 14:5340. [PMID: 36558499 PMCID: PMC9785595 DOI: 10.3390/nu14245340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Over recent years, non-alcoholic fatty liver disease (NAFLD) has become the most common liver disorder in the developed world, accounting for 20% to 46% of liver abnormalities. Steatosis is the hallmark of NAFLD and is recognized as an important risk factor for complication and death after general surgery, even more so after liver resection. Similarly, liver steatosis also impacts the safety of live liver donation and transplantation. We aim to review surgical outcomes after liver resection for colorectal metastases in patients with steatosis and discuss the most common pre-operative strategies to reduce steatosis. Finally, as illustration, we report the favorable effect of a low-caloric, hyper-protein diet during a two-stage liver resection for colorectal metastases in a patient with severe steatosis.
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Affiliation(s)
- Andrea Peloso
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
| | - Matthieu Tihy
- Department of Pathology and Immunology, University of Geneva, 1205 Geneva, Switzerland
- Division of Clinical Pathology, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Beat Moeckli
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Department of Pathology and Immunology, University of Geneva, 1205 Geneva, Switzerland
- Division of Clinical Pathology, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Christian Toso
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
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3
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Yazaki T, Kawashima K, Ishimura N, Kataoka M, Fukunaga M, Hyakudomi R, Tajima Y, Moriyama I, Araki A, Kadota K, Shibagaki K, Tobita H, Ishihara S. Oxaliplatin-related Portal Hypertension Complicated with Esophageal Varices and Refractory Massive Ascites. Intern Med 2022; 61:3225-3231. [PMID: 35370236 PMCID: PMC9683804 DOI: 10.2169/internalmedicine.9266-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/13/2022] [Indexed: 12/17/2022] Open
Abstract
Oxaliplatin, widely used as a chemotherapy drug for colorectal cancer, is known to cause various adverse reactions. In particular, special attention for the development of portal hypertension associated with porto-sinusoidal vascular disease is necessary, as it is a serious adverse life-threating reaction, although rare. We herein report a case of oxaliplatin-related portal hypertension that developed several years after oxaliplatin administration and led to esophageal varices and refractory massive ascites. Clinical physicians should be aware of the possibility of oxaliplatin-induced portal hypertension and its possible development over a long period after discontinuation of the drug.
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Affiliation(s)
- Tomotaka Yazaki
- Department of Hepatology, Shimane University Faculty of Medicine, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Masatoshi Kataoka
- Department of Hepatology, Shimane University Faculty of Medicine, Japan
| | - Mai Fukunaga
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Japan
| | - Ichiro Moriyama
- Division of Innovative Cancer Center, Shimane University Hospital, Japan
| | - Asuka Araki
- Department of Pathology, Shimane University Faculty of Medicine, Japan
| | - Kyuichi Kadota
- Department of Pathology, Shimane University Faculty of Medicine, Japan
| | | | - Hiroshi Tobita
- Department of Hepatology, Shimane University Faculty of Medicine, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
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4
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Efficacy Evaluation of Neoadjuvant Chemotherapy in Breast Cancer by MRI. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:4542288. [PMID: 36017018 PMCID: PMC9371822 DOI: 10.1155/2022/4542288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 12/03/2022]
Abstract
Breast cancer is a highly harmful malignancy, which often causes great distress to patients and seriously affects their physical and mental health. Breast cancer causes patients to experience decreased appetite, decreased eating, and indigestion, which in turn leads to malnutrition, body wasting, resistance, immune compromise, progressive anemia, cachexia, and, as a result, severe secondary infections. To investigate the efficacy evaluation of neoadjuvant chemotherapy in breast cancer by MRI, forty-eight subjects treated at the hospital from June 2014 to August 2019 were recruited. After the neoadjuvant chemotherapy, the patients were divided into two groups based on the results of histopathological examination, namely, the ineffective group (n = 14) and the effective group (n = 34). Changes in MRI indicators were compared between the two groups before and after the neoadjuvant chemotherapy. The maximum diameter of lesions decreased significantly after the neoadjuvant chemotherapy than before. The apparent diffusion coefficient (ADC) increased considerably, and the time-intensity curve (TIC) showed a transition from type III to type II/I and from type II to type I. MRI can indicate the maximum diameter of the breast cancer lesion, ADC, and TIC type. Therefore, it can be used to evaluate the efficacy of neoadjuvant chemotherapy for breast cancer and be widely applied in clinical practice.
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5
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Vigano L, Terrone A, Costa G, Franchi E, Cimino M, Procopio F, Del Fabbro D, Torzilli G. Effect of chemotherapy on tumour-vessel relationship in colorectal liver metastases. Br J Surg 2022; 109:401-404. [PMID: 35165692 DOI: 10.1093/bjs/znac010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Luca Vigano
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alfonso Terrone
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Guido Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Eloisa Franchi
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Matteo Cimino
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Fabio Procopio
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Daniele Del Fabbro
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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6
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Does Chemotherapy-Induced Liver Injury Impair Postoperative Outcomes After Laparoscopic Liver Resection for Colorectal Metastases? J Gastrointest Surg 2021; 25:1203-1211. [PMID: 32410180 DOI: 10.1007/s11605-020-04636-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/25/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chemotherapy-associated liver injuries (CALI) have been associated with poor postoperative outcome after open liver resection. To date, no data concerning any correlation of CALI and laparoscopic liver resection (LLR) are available. In the present study, we evaluated the impact of CALI on short-term outcomes in patients undergoing LLR. MATERIALS AND METHODS All patients who underwent in our department LLR for colorectal liver metastases (CRLM) from 2000 to 2016 were retrospectively reviewed. Patients were divided in 4 groups according to their pathological histology. In group 1 patients had normal liver parenchyma. Group 2 included patients with steatosis and steatohepatitis. Patients with sinusoidal obstruction syndrome (SOS) and nodular regenerative hyperplasia (NRH) were allocated to group 3, whereas the remaining with fibrosis and cirrhosis, were assigned to group 4. RESULTS A total of 490 LLR for CRLM were included in the study. Perioperative details and morbidity did not differ significantly between the four groups. Subgroup analysis showed that NRH was associated with higher amount of blood loss (p = 0.043), overall (p = 0.021) and liver-specific morbidity (p = 0.039). CONCLUSION NRH is a severe form of CALI that may worsen the short-term outcomes of patients undergoing LLR for CRLM. However, the remaining forms of CALI do not have a significant impact on perioperative outcomes after LLR.
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7
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An overview of acute gastrointestinal side effects of systemic anti-cancer therapy and their management. Best Pract Res Clin Gastroenterol 2020; 48-49:101691. [PMID: 33317796 DOI: 10.1016/j.bpg.2020.101691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/06/2020] [Indexed: 01/31/2023]
Abstract
Treatment-related acute gastrointestinal toxicities are a common and often debilitating hurdle encountered in the treatment of cancer patients. While the introduction of targeted therapies such as tyrosine kinase inhibitors has led to improvements in survival outcomes, their use has also been complicated by a high frequency of clinically important adverse effects. Gastrointestinal toxicities such as nausea, vomiting, diarrhoea and hepatotoxicity represent potentially serious adverse events that may necessitate dose reductions, treatment interruptions and cessation of treatment. An improved knowledge of the incidence, pathophysiology, management and prophylaxis of these toxicities is crucial in order to reduce patient morbidity and mortality. In this review, we discuss the main gastrointestinal toxicities associated with chemotherapy and targeted therapies in oncology, outlining their incidence, pathophysiology and expert management guidelines.
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8
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Parmar KL, O'Reilly D, Valle JW, Braun M, Naish JH, Williams SR, Lloyd WK, Malcomson L, Cresswell K, Bamford C, Renehan AG. Prospective study of change in liver function and fat in patients with colorectal liver metastases undergoing preoperative chemotherapy: protocol for the CLiFF Study. BMJ Open 2020; 10:e027630. [PMID: 32967864 PMCID: PMC7513559 DOI: 10.1136/bmjopen-2018-027630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Preoperative chemotherapy in patients undergoing resection for colorectal liver metastases (CLM) improves oncological outcomes. However, chemotherapy-associated liver injury (occurring in two patterns: vascular and fat deposition) is a real clinical concern prior to hepatic resection. After major liver resection, regeneration of the residual liver is a prerequisite for recovery and avoidance of liver failure, but this regenerative capacity may be hindered by chemotherapy. Thus, there is a need to predict for this serious complication. Over the past two decades, several tests and derived indices have been developed, which have failed to achieve clinical utility, mainly as they were indirect measurements of liver function. Here, we will use a novel test of liver function (the liver maximum capacity (LiMAx) test), and measure liver fat using MRI. METHODS AND ANALYSIS This prospective study will assess changes in liver function longitudinally, measured by the LiMAx test, and liver fat, measured by advanced MRI using both MR spectroscopy and the modified Dixon method, in up to 35 patients undergoing preoperative chemotherapy for CLM. The primary outcomes will be the changes in liver function and fat compared with baseline prechemotherapy measurements. Secondary outcome measures include: routinely measured liver function blood tests, anthropometric measurements, postoperative histology and digital quantification of fat, postoperative complications and mortality and quality of life. ETHICS AND DISSEMINATION The study was approved by a National Health Service Research Ethics Committee and registered with the Health Research Authority. Dissemination will be via international and national conferences and the National Institute for Health Research network. Manuscripts will be published. TRIAL REGISTRATION NUMBER This study is registered online at www.clinicaltrials.gov (registration number NCT03562234).
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Affiliation(s)
- Kat L Parmar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Cancer Research Centre, Manchester, UK
| | - Derek O'Reilly
- Hepatobiliary Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Juan W Valle
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Oncology, Christie NHS Foundation Trust, Manchester, UK
| | - Michael Braun
- Oncology, Christie NHS Foundation Trust, Manchester, UK
| | - Jo H Naish
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Steve R Williams
- Centre for Imaging Sciences, University of Manchester, Manchester, UK
| | - William K Lloyd
- Centre for Imaging Sciences, University of Manchester, Manchester, UK
| | - Lee Malcomson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Surgery, Christie NHS Foundation Trust, Manchester, UK
| | - Katharine Cresswell
- Public Programmes Team, Research and Innovation Division, Manchester University NHS Foundation Trust, Manchester, UK
| | - Colin Bamford
- Cancer Patient and Public Advisory Group, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Surgery, Christie NHS Foundation Trust, Manchester, UK
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9
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Truant S, Baillet C, Gnemmi V, Fulbert M, Turpin A, Dardenne S, Leteurtre E, El Amrani M, Dharancy S, Dubuquoy L, Huglo D, Chesné C, Pruvot FR. The Impact of Modern Chemotherapy and Chemotherapy-Associated Liver Injuries (CALI) on Liver Function: Value of 99mTc-Labelled-Mebrofenin SPECT-Hepatobiliary Scintigraphy. Ann Surg Oncol 2020; 28:1959-1969. [PMID: 32833150 DOI: 10.1245/s10434-020-08988-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/16/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chemotherapy is increasingly used before hepatic resection, with controversial impact regarding liver function. This study aimed to assess the capacity of 99mTc-labelled-mebrofenin SPECT-hepatobiliary scintigraphy (HBS) to predict liver dysfunction due to chemotherapy and/or chemotherapeutic-associated liver injuries (CALI), such as sinusoidal obstruction syndrome (SOS) and nonalcoholic steatohepatitis (NASH) activity score (NAS). METHODS From 2011 to 2015, all consecutive noncirrhotic patients scheduled for a major hepatectomy (≥ 3 segments) gave informed consent for preoperative SPECT-HBS allowing measurements of segmental liver function. As primary endpoint, HBS results were compared between patients with versus without (1) preoperative chemotherapy (≤ 3 months); and (2) CALI, mainly steatosis, NAS (Kleiner), or SOS (Rubbia-Brandt). Secondary endpoints were (1) other factors impairing function; and (2) impact of chemotherapy, and/or CALI on hepatocyte isolation outcome via liver tissues. RESULTS Among 115 patients, 55 (47.8%) received chemotherapy. Sixteen developed SOS and 35 NAS, with worse postoperative outcome. Overall, chemotherapy had no impact on liver function, except above 12 cycles. In patients with CALI, a steatosis ≥ 30% significantly compromised function, as well as NAS, especially grades 2-5. Conversely, SOS had no impact, although subjected to very low patients number with severe SOS. Other factors impairing function were diabetes, overweight/obesity, or fibrosis. Similarly, chemotherapy in 73 of 164 patients had no effect on hepatocytes isolation outcome; regarding CALI, steatosis ≥ 30% and NAS impaired the yield and/or viability of hepatocytes, but not SOS. CONCLUSIONS In this first large, prospective study, HBS appeared to be a valuable tool to select heavily treated patients at risk of liver dysfunction through steatosis or NAS.
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Affiliation(s)
- Stéphanie Truant
- Department of Digestive Surgery and Transplantation, Univ. Lille, CHRU Lille, Lille, France. .,CANTHER laboratory Cancer Heterogeneity, Plasticity and Resistance to Therapies UMR-S1277 INSERM, Team Mucins, Cancer and Drug Resistance, 59000, Lille, France.
| | - Clio Baillet
- Department of Nuclear Medicine, Univ. Lille, Lille, France
| | | | - Maxence Fulbert
- Department of Digestive Surgery and Transplantation, Univ. Lille, CHRU Lille, Lille, France
| | - Anthony Turpin
- Department of Medical Oncology, Univ. Lille, Lille, France
| | - Sabrina Dardenne
- Department of Digestive Surgery and Transplantation, Univ. Lille, CHRU Lille, Lille, France
| | | | - Mehdi El Amrani
- Department of Digestive Surgery and Transplantation, Univ. Lille, CHRU Lille, Lille, France.,CANTHER laboratory Cancer Heterogeneity, Plasticity and Resistance to Therapies UMR-S1277 INSERM, Team Mucins, Cancer and Drug Resistance, 59000, Lille, France
| | - Sébastien Dharancy
- Hepatology Unit, Univ. Lille, Lille, France.,LIRIC-Lille Inflammation Research International Center-U995, Univ. Lille, Inserm, CHU Lille, Lille, France
| | - Laurent Dubuquoy
- Hepatology Unit, Univ. Lille, Lille, France.,LIRIC-Lille Inflammation Research International Center-U995, Univ. Lille, Inserm, CHU Lille, Lille, France
| | - Damien Huglo
- Department of Nuclear Medicine, Univ. Lille, Lille, France
| | | | - François-René Pruvot
- Department of Digestive Surgery and Transplantation, Univ. Lille, CHRU Lille, Lille, France
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10
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Gangi A, Lu SC. Chemotherapy-associated liver injury in colorectal cancer. Therap Adv Gastroenterol 2020; 13:1756284820924194. [PMID: 32547639 PMCID: PMC7249601 DOI: 10.1177/1756284820924194] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/15/2020] [Indexed: 02/04/2023] Open
Abstract
Patients with colorectal cancer (CRC) have benefited significantly from advances in multimodal treatment with significant improvements in long-term survival. More patients are currently being treated with surgical resection or ablation following neoadjuvant or adjuvant chemotherapy. However, several cytotoxic agents that are administered routinely have been linked to liver toxicities that impair liver function and regeneration. Recognition of chemotherapy-related liver toxicity emphasizes the importance of multidisciplinary planning to optimize care. This review aims to summarize current data on multimodal treatment concepts for CRC, provide an overview of liver damage caused by commonly administered chemotherapeutic agents, and evaluate currently suggested protective agents.
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Affiliation(s)
- Alexandra Gangi
- Division of Surgical Oncology, Department of Surgery, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
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11
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Beal EW, Suarez-Kelly LP, Kimbrough CW, Johnston FM, Greer J, Abbott DE, Pokrzywa C, Raoof M, Lee B, Grotz TE, Leiting JL, Fournier K, Lee AJ, Dineen SP, Powers B, Veerapong J, Baumgartner JM, Clarke C, Mogal H, Russell MC, Zaidi MY, Patel SH, Dhar V, Lambert L, Hendrix RJ, Hays J, Abdel-Misih S, Cloyd JM. Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review. J Clin Med 2020; 9:748. [PMID: 32164300 PMCID: PMC7141272 DOI: 10.3390/jcm9030748] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/13/2022] Open
Abstract
Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival for patients with colorectal peritoneal metastases (CR-PM). However, the role of neoadjuvant chemotherapy (NAC) prior to CRS-HIPEC is poorly understood. A retrospective review of adult patients with CR-PM who underwent CRS+/-HIPEC from 2000-2017 was performed. Among 298 patients who underwent CRS+/-HIPEC, 196 (65.8%) received NAC while 102 (34.2%) underwent surgery first (SF). Patients who received NAC had lower peritoneal cancer index score (12.1 + 7.9 vs. 14.3 + 8.5, p = 0.034). There was no significant difference in grade III/IV complications (22.4% vs. 16.7%, p = 0.650), readmission (32.3% vs. 23.5%, p = 0.114), or 30-day mortality (1.5% vs. 2.9%, p = 0.411) between groups. NAC patients experienced longer overall survival (OS) (median 32.7 vs. 22.0 months, p = 0.044) but similar recurrence-free survival (RFS) (median 13.8 vs. 13.0 months, p = 0.456). After controlling for confounding factors, NAC was not independently associated with improved OS (OR 0.80) or RFS (OR 1.04). Among patients who underwent CRS+/-HIPEC for CR-PM, the use of NAC was associated with improved OS that did not persist on multivariable analysis. However, NAC prior to CRS+/-HIPEC was a safe and feasible strategy for CR-PM, which may aid in the appropriate selection of patients for aggressive cytoreductive surgery.
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Affiliation(s)
- Eliza W. Beal
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43201, USA; (E.W.B.); (L.P.S.-K.); (C.W.K.); (J.H.); (S.A.-M.)
| | - Lorena P. Suarez-Kelly
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43201, USA; (E.W.B.); (L.P.S.-K.); (C.W.K.); (J.H.); (S.A.-M.)
| | - Charles W. Kimbrough
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43201, USA; (E.W.B.); (L.P.S.-K.); (C.W.K.); (J.H.); (S.A.-M.)
| | - Fabian M. Johnston
- Department of Surgery, Division of Surgical Oncology, Johns Hopkins University, Baltimore, MD 21205, USA; (F.M.J.); (J.G.)
| | - Jonathan Greer
- Department of Surgery, Division of Surgical Oncology, Johns Hopkins University, Baltimore, MD 21205, USA; (F.M.J.); (J.G.)
| | - Daniel E. Abbott
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI 53792, USA; (D.E.A.); (C.P.)
| | - Courtney Pokrzywa
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI 53792, USA; (D.E.A.); (C.P.)
| | - Mustafa Raoof
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA; (M.R.); (B.L.)
| | - Byrne Lee
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA; (M.R.); (B.L.)
| | - Travis E. Grotz
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN 55905, USA; (T.E.G.); (J.L.L.)
| | - Jennifer L. Leiting
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN 55905, USA; (T.E.G.); (J.L.L.)
| | - Keith Fournier
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 44907, USA; (K.F.); (A.J.L.)
| | - Andrew J. Lee
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 44907, USA; (K.F.); (A.J.L.)
| | - Sean P. Dineen
- Department of Gastrointestinal Surgery, Moffitt Cancer Center, Tampa, FL 33612, USA; (S.P.D.); (B.P.)
| | - Benjamin Powers
- Department of Gastrointestinal Surgery, Moffitt Cancer Center, Tampa, FL 33612, USA; (S.P.D.); (B.P.)
| | - Jula Veerapong
- Department of Surgery, Division of Surgical Oncology, University of California San Diego, San Diego, CA 92093, USA; (J.V.); (J.M.B.)
| | - Joel M. Baumgartner
- Department of Surgery, Division of Surgical Oncology, University of California San Diego, San Diego, CA 92093, USA; (J.V.); (J.M.B.)
| | - Callisia Clarke
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milkwaukee, WI 53226, USA; (C.C.); (H.M.)
| | - Harveshp Mogal
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milkwaukee, WI 53226, USA; (C.C.); (H.M.)
| | - Marti C. Russell
- Winship Cancer Institute, Division of Surgical Oncology, Emory University, Atlanta, GA 30322, USA; (M.C.R.); (M.Y.Z.)
| | - Mohammed Y. Zaidi
- Winship Cancer Institute, Division of Surgical Oncology, Emory University, Atlanta, GA 30322, USA; (M.C.R.); (M.Y.Z.)
| | - Sameer H. Patel
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA; (S.H.P.); (V.D.)
| | - Vikrom Dhar
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA; (S.H.P.); (V.D.)
| | - Laura Lambert
- Department of Surgery, Division of Surgical Oncology, University of Massachusetts Memorial Medical Center, Worcester, MA 45219, USA; (L.L.); (R.J.H.)
| | - Ryan J. Hendrix
- Department of Surgery, Division of Surgical Oncology, University of Massachusetts Memorial Medical Center, Worcester, MA 45219, USA; (L.L.); (R.J.H.)
| | - John Hays
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43201, USA; (E.W.B.); (L.P.S.-K.); (C.W.K.); (J.H.); (S.A.-M.)
| | - Sherif Abdel-Misih
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43201, USA; (E.W.B.); (L.P.S.-K.); (C.W.K.); (J.H.); (S.A.-M.)
| | - Jordan M. Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43201, USA; (E.W.B.); (L.P.S.-K.); (C.W.K.); (J.H.); (S.A.-M.)
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12
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Garcia-Botella A, Sáez-Carlin P, Méndez R, Martin MP, Ortega L, Méndez JV, García-Paredes B, Diez-Valladares L, Torres AJ. 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. Surg Oncol 2019; 33:224-230. [PMID: 32561087 DOI: 10.1016/j.suronc.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment of liver metastases of colorectal carcinoma is surgical resection. However, only 10-15% of the patients in this context will be candidate for curative resection arising other 10-13% after response to neoadyuvant chemotherapy. In order to perform the liver metastases surgery, it is necessary to have a sufficient remnant liver volume (RLV) which allows maintaining an optimal liver function after resection. Studies on liver regeneration have determined that CD133 + stem cells are involved in liver hypertrophy developed after an hepatectomy with encouraging results. As presented in previous studies, CD133 + stem cells can be selected from peripheral blood after stimulation with G-CSF, being able to obtain a large number of them. We propose to treat patients who do not meet criteria for liver metastases surgery because of insufficient RLV (<40%) with CD133 + cells together with portal embolization, in order to achieve enough liver volume which avoids liver failure. METHODS /Design: The aim of this study is to evaluate the effectiveness of preoperative PVE plus the administration of CD133 + mobilized from peripheral blood with G-CSF compared to PVE only. SECONDARY AIMS ARE: to compare the grade of hypertrophy, speed and changes in liver function, anatomopathological study of hypertrophied liver, to determine the safety of the treatment and analysis of postoperative morbidity and surveillance. STUDY DESIGN Prospective randomized longitudinal phase IIb clinical trial, open, to evaluate the efficacy of portal embolization (PVE) together with the administration of CD133 + cells obtained from peripheral blood versus PVE alone, in patients with hepatic metastasis of colorectal carcinoma (CCRHM). DISCUSSION The number of CD133 + obtained from peripheral blood after G -CSF stimulation will be far greater than the number obtained with direct puncture of bone marrow. This will allow a greater intrahepatic infusion, which could have a direct impact on achieving a larger and quicker hypertrophy. Consequently, it will permit the treatment of a larger number of patients with an increase on their survival. TRIAL REGISTRATION ClinicalTrials.gov, ID NCT03803241.
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Affiliation(s)
| | - Patricia Sáez-Carlin
- Surgery (HepatoPancreatoBiliary Unit), Hospital Clínico San Carlos Madrid, Spain.
| | - Ramiro Méndez
- Department of Radiology, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - Maria Paz Martin
- Department o Hematology, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - Luis Ortega
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain.
| | - Jose Vicente Méndez
- Department of Radiology, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | | | - L Diez-Valladares
- Surgery (HepatoPancreatoBiliary Unit), Hospital Clínico San Carlos Madrid, Spain.
| | - Antonio Jose Torres
- Surgery (HepatoPancreatoBiliary Unit), Hospital Clínico San Carlos Madrid, Spain.
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13
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Hepatic steatosis in patients undergoing resection of colorectal liver metastases: A target for prehabilitation? A narrative review. Surg Oncol 2019; 30:147-158. [PMID: 31471139 DOI: 10.1016/j.suronc.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 06/20/2019] [Accepted: 07/22/2019] [Indexed: 12/16/2022]
Abstract
The prevalence of elevated intra-hepatic fat (IHF) is increasing in the Western world, either alone as hepatic steatosis (HS) or in conjunction with inflammation (steatohepatitis). These changes to the hepatic parenchyma are an independent risk factor for post-operative morbidity following liver resection for colorectal liver metastases (CRLM). As elevated IHF and colorectal malignancy share similar risk factors for development it is unsurprisingly frequent in this cohort. In patients undergoing resection IHF may be elevated due to excess adiposity or its elevation may be induced by neoadjuvant chemotherapy, termed chemotherapy associated steatosis (CAS). Additionally, chemotherapy is implicated in the development of inflammation termed chemotherapy associated steatohepatitis (CASH). Following cessation of chemotherapy, patients awaiting resection have a 4-6 week washout period prior to resection that is a window for prehabilitation prior to surgery. In patients with NAFLD dietary and pharmacological interventions can reduce IHF within this timeframe but this approach to modifying IHF is untested in this population. In this review, the aetiology of CAS and CASH is reviewed with recommendations to identify those at risk. We also focus on the post-chemotherapy washout period, reviewing dietary interventions applied to the metabolic population and suggest this window may be used as an opportunity to optimise IHF with such a regime as part of a pre-operative prehabilitation programme to produce improved patient outcomes.
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14
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Yamazaki S, Takayama T. Current topics in liver surgery. Ann Gastroenterol Surg 2019; 3:146-159. [PMID: 30923784 PMCID: PMC6422805 DOI: 10.1002/ags3.12233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/02/2018] [Accepted: 12/04/2018] [Indexed: 01/01/2023] Open
Abstract
Liver resection is one of the main treatment strategies for liver malignancies. Mortality and morbidity of liver surgery has improved significantly with progress in selection criteria, development of operative procedures and improvements in perioperative management. Safe liver resection has thus become more available worldwide. We have identified four current topics related to liver resection (anatomical liver resection, laparoscopic liver resection, staged liver resection and chemotherapy-induced liver injury). The balance between treatment effect and patient safety needs to be considered when planning liver resection. Progress in this area has been rapid thanks to the efforts of many surgeons, and outcomes have improved significantly as a result. These topics remain to be solved and more robust evidence is needed. Precise selection of the optimal procedure and risk evaluation should be standardized with further development of each topic. The present article reviews these four current topics with a focus on safety and efficacy in recent series.
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Affiliation(s)
- Shintaro Yamazaki
- Department of Digestive SurgeryNihon University School of MedicineTokyoJapan
| | - Tadatoshi Takayama
- Department of Digestive SurgeryNihon University School of MedicineTokyoJapan
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15
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Viganò L, Costa G, Cimino MM, Procopio F, Donadon M, Del Fabbro D, Belghiti J, Kokudo N, Makuuchi M, Vauthey JN, Torzilli G. R1 Resection for Colorectal Liver Metastases: a Survey Questioning Surgeons about Its Incidence, Clinical Impact, and Management. J Gastrointest Surg 2018; 22:1752-1763. [PMID: 29948554 DOI: 10.1007/s11605-018-3820-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/15/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND A ≥ 1-mm margin is standard for resection of colorectal liver metastases (CLM). However, R1 resection is not rare (10-30%), and chemotherapy could mitigate its impact. The possibility of detaching CLM from vessels (R1 vascular margin) has been described. A reappraisal of R1 resection is needed. METHODS A 19-question survey regarding R1 resection for CLM was sent to hepatobiliary surgeons worldwide. Seven clinical cases were included. RESULTS In total, 276 surgeons from 52 countries completed the survey. Ninety percent reported a negative impact of R1 resection (74% local recurrence, 31% hepatic recurrence, and 36% survival), but 50% considered it sometimes required for resectability. Ninety-one percent of responders suggested that the impact of R1 resection is modulated by the response to chemotherapy and/or CLM characteristics. Half considered the risk of R1 resection to be an indication for preoperative chemotherapy in patients who otherwise underwent upfront resection, and 40% modified the chemotherapy regimen when the tumor response did not guarantee R0 resection. Nevertheless, 80% scheduled R1 resection for multiple bilobar CLM that responded to chemotherapy. Forty-five percent considered the vascular margin equivalent to R0 resection. However, for lesions in contact with the right hepatic vein, right hepatectomy remained the standard. Detachment from the vein was rarely considered (10%), but 27% considered detachment in the presence of multiple bilobar CLM. CONCLUSIONS A negative margin is still standard for CLM, but R1 resection is no longer just a technical error. R1 resection should be part of the modern multidisciplinary, aggressive approach to CLM.
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Affiliation(s)
- Luca Viganò
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Guido Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Matteo Maria Cimino
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Fabio Procopio
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Matteo Donadon
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Daniele Del Fabbro
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Jacques Belghiti
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Norihiro Kokudo
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masatoshi Makuuchi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
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16
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Mallick P, Shah P, Ittmann MM, Trivedi M, Hu M, Gao S, Ghose R. Impact of diet on irinotecan toxicity in mice. Chem Biol Interact 2018; 291:87-94. [DOI: 10.1016/j.cbi.2018.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/01/2018] [Accepted: 06/14/2018] [Indexed: 12/20/2022]
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17
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Chan KM, Wu TH, Wang YC, Lee CF, Wu TJ, Chou HS, Lee WC, Chiang JM, Chen JS. Clinical relevance of oncologic prognostic factors in the decision-making of pre-hepatectomy chemotherapy for colorectal cancer hepatic metastasis: the priority of hepatectomy. World J Surg Oncol 2018; 16:24. [PMID: 29415722 PMCID: PMC5804072 DOI: 10.1186/s12957-018-1322-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/23/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although liver resection (LR) provides the best chance of long-term survival for patients with colorectal cancer (CRC) hepatic metastasis, concerns regarding chemotherapy before liver resection remain unresolved. METHODS A retrospective review of patients who underwent curative LR for CRC hepatic metastasis between January 2008 and February 2016 was performed. Outcome relevance based on oncologic prognostic factors and chemotherapy prior to liver resection was assessed. RESULTS Patients who had received pre-hepatectomy chemotherapy for CRC hepatic metastasis and delayed liver resection had a worse outcome in terms of CRC recurrence following liver resection. The hazard ratio (HR) of pre-hepatectomy chemotherapy in patients with minor oncologic prognostic factors was 1.55 (confidence interval, CI = 1.07-2.26, p = 0.021) for CRC recurrence after liver resection for hepatic metastasis, whereas the HR of pre-hepatectomy chemotherapy was 1.34 (CI = 0.99-1.81, p = 0.062) for CRC recurrence in patients with multiple oncologic prognostic factors. CONCLUSION The administration of pre-hepatectomy chemotherapy and delaying liver resection seems not to be an optimal strategy to provide a clinical benefit for patients with CRC hepatic metastasis. Hence, liver resection should be attempted without delay at the initial detection of CRC hepatic metastasis whenever possible.
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Affiliation(s)
- Kun-Ming Chan
- Division of Liver and Organ Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305 Taiwan
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305 Taiwan
| | - Tsung-Han Wu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305 Taiwan
| | - Yu-Chao Wang
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305 Taiwan
| | - Chen-Fang Lee
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305 Taiwan
| | - Ting-Jung Wu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305 Taiwan
| | - Hong-Shiue Chou
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305 Taiwan
| | - Wei-Chen Lee
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305 Taiwan
| | - Jy-Ming Chiang
- Department of Colorectal Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305 Taiwan
| | - Jinn-Shiun Chen
- Department of Colorectal Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305 Taiwan
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18
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Cetin B, Yılmaz GE, Armagan B, Afsar B, Demirci U, Gulbahar O, Gumusay O, Bilgetekin I, Ozet A, Uner A. Pazopanib-Induced Hepatotoxicity in an Experimental Rat Model. Chemotherapy 2018; 63:39-45. [PMID: 29393107 DOI: 10.1159/000481795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/25/2017] [Indexed: 12/14/2022]
Abstract
Pazopanib is an effective treatment for advanced renal cell carcinoma and soft tissue sarcoma. Besides classical adverse events of this drug class, hepatotoxicity has been described as a frequent side effect. The aim of the present study was to evaluate the effect of pazopanib on the liver in an experimental rat model. Sixteen Wistar albino rats were divided into 3 groups: experimental toxicity was induced with pazopanib (10 mg/kg) administered for 28 days (group 2) or 56 days (group 3) orally by gavage. Group 1 (control group) received only distilled water. Rats in groups 2 and 3 were sacrificed after the collection of blood and tissue samples on the 28th and 56th days, respectively. We found significant differences in bilirubin, alkaline phosphatase, lactate dehydrogenase, glucose, triglyceride, very-low-density lipoprotein, and iron values (p < 0.050 for all) but none in any other parameter (p > 0.050). All rats in the control group had normal histological features; however, none of the rats in groups 2 and 3 showed normal histology. In group 2, we observed mild sinusoidal dilatation, congestion, enlarged Kupffer cells, accumulation of yellow-brown-black pigment in the Kupffer cells and the accumulation of hemosiderin with Prussian blue reaction in the hepatocytes. In group 3, the findings mentioned above were more prominent, and besides these findings focal acinar transformation and macrovesicular steatosis were also observed. In group 3, mild inflammation within the portal areas was observed consisting of lymphocytes, neutrophils, and eosinophils. This study is the first that reports the biochemical and histopathological evaluation of pazopanib-related hepatic toxicity.
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Affiliation(s)
- Bulent Cetin
- Department of Internal Medicine, Division of Medical Oncology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
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19
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Wang K, Liu W, Yan XL, Li J, Xing BC. Long-term postoperative survival prediction in patients with colorectal liver metastasis. Oncotarget 2017; 8:79927-79934. [PMID: 29108374 PMCID: PMC5668107 DOI: 10.18632/oncotarget.20322] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/05/2017] [Indexed: 12/11/2022] Open
Abstract
Numerous factors affect the prognosis of colorectal liver metastasis (CRLM) patients after hepatic resection. We investigated several factors related to overall survival in patients with CRLM to identify those most likely to benefit from hepatic resection, and produced a rational tumor biology score system. Three hundred CRLM patients treated with preoperative chemotherapy followed by hepatic resection between 2006 and 2016 were enrolled in our study. Clinicopathologic and long-term survival data were collected and assessed. Patient 1-, 3-, and 5-year overall survival rates were 92.7%, 58.3%, and 45.8%, respectively, while 1-, 3-, and 5-year disease-free survival rates were 44.7%, 28.6%, and 24.2%, respectively. Multivariate Cox regression analysis revealed poor preoperative chemotherapy response, Fong clinical risk score > 2, and KRAS mutation to be independent prognostic indicators in CRLM patients. As part of a preoperative staging system in which one point was assigned for each factor, a total score (out of 3) was predictive of long-term survival following surgery. These factors facilitate personalized prognostic assessments in CRLM patients planning for resection.
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Affiliation(s)
- Kun Wang
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, PR China
| | - Wei Liu
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, PR China
| | - Xiao-Luan Yan
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, PR China
| | - Juan Li
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, PR China
| | - Bao-Cai Xing
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, PR China
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20
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Clarke CN, Choi H, Hou P, Davis CH, Ma J, Rashid A, Vauthey JN, Aloia TA. Using MRI to non-invasively and accurately quantify preoperative hepatic steatosis. HPB (Oxford) 2017; 19:706-712. [PMID: 28528267 DOI: 10.1016/j.hpb.2017.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/10/2017] [Accepted: 04/10/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The obesity epidemic has significantly increased the incidence and severity of hepatic steatosis in liver surgery patients and liver donors, potentially impacting postoperative liver regeneration and function. Development of a non-invasive means to quantify hepatic steatosis would facilitate selection of candidates for liver resection and transplant donation. METHODS An IRB-approved protocol prospectively enrolled 28 patients with liver tumors requiring hepatic resection. In all patients, fast dual-echo gradient-echo MR images were acquired using 2-Point Dixon technique in 2D and 3D. The degree of steatosis was quantified by percent fat fraction (%FF) from in- and out-of-phase, and water-only and fat-only images. The technique-specific %FFs were compared to intraoperative and histopathological findings. RESULTS For patients with >30% steatosis by histology, the mean %FF was 22% (SD ± 5.2%) compared to a mean %FF of 5.0% (SD ± 2.1%, p = 0.0001) in patients with <30% steatosis. Using scaled values for the MR-calculated %FF, all patients with >30% pathologic steatosis could be identified preoperatively. CONCLUSIONS Quantitative MRI identified patients with clinically-relevant steatosis with 100% accuracy. These findings could have significant impact on the management of liver resection patients and transplant donors.
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Affiliation(s)
- Callisia N Clarke
- Division of Surgical Oncology, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Haesun Choi
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Catherine H Davis
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Asif Rashid
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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21
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Mignot A, Ayav A, Quillot D, Zuily S, Petit I, Nguyen-Thi PL, Malgras A, Laurent V. Extensive lymph node dissection during pancreaticoduodenectomy: a risk factor for hepatic steatosis? Abdom Radiol (NY) 2017; 42:1880-1887. [PMID: 28357531 DOI: 10.1007/s00261-017-1087-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The first reports of hepatic steatosis following pancreaticoduodenectomy (PD) were published several years ago; however, clear risk factors remain to be identified. Therefore, the aim of this study was to identify the risk factors for hepatic steatosis post-PD. METHODS We studied 90 patients who had undergone PD between September 2005 and January 2015. The inclusion criteria were as follows: available unenhanced CT within one month before PD and at least one unenhanced CT acquisition between PD and chemotherapy initiation. Using scanners, we studied the liver and spleen density as well as the surface areas of visceral (VF) and subcutaneous fat (SCF). These variables were previously identified by univariate and multivariate analyses. RESULTS Hepatic steatosis occurred in 25.6% of patients at 45.2 days, on average, post-PD. Among the patients with hepatic steatosis, the average liver density was 52 HU before PD and 15.1 HU post-PD (p < 0.001). The Patients with hepatic steatosis lost more VF (mean, 28 vs. 11 cm2) and SCF (28.8 vs. 13.7 cm2) (p < 0.01 and p = 0.01, respectively). Portal vein resection and extensive lymph node dissection were independent risk factors in the multivariate analysis (odds ratio [OR] 5.29, p = 0.009; OR 3.38, p = 0.04, respectively). CONCLUSION Portal vein resection and extensive lymph node dissection are independent risk factors for post-PD hepatic steatosis.
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Affiliation(s)
- A Mignot
- Department of Radiology, CHU Nancy Brabois, Vandœuvre-lès-Nancy, 54500, France.
- , 6 rue Jean XXIII Résidence Haut Rivage, 54130, Saint Max, France.
| | - A Ayav
- Department of Hepato-Pancreato-Biliary Surgery, CHU Nancy Brabois, Vandœuvre-lès-Nancy, 54500, France
| | - D Quillot
- Department of Diabetes and Nutrition, CHU Nancy Brabois, Vandœuvre-lès-Nancy, 54500, France
| | - S Zuily
- Department of Cardiovascular Medicine, CHU Nancy Brabois, Vandœuvre-lès-Nancy, 54500, France
| | - I Petit
- Department of Radiology, CHU Nancy Brabois, Vandœuvre-lès-Nancy, 54500, France
| | - P L Nguyen-Thi
- Department of PARC, ESPRI-BIOBASE, Pôle S, CHU Nancy Brabois, Vandœuvre-lès-Nancy, 54500, France
| | - A Malgras
- Department of Diabetes and Nutrition, CHU Nancy Brabois, Vandœuvre-lès-Nancy, 54500, France
| | - V Laurent
- Department of Radiology, CHU Nancy Brabois, Vandœuvre-lès-Nancy, 54500, France
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22
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Vigano L, De Rosa G, Toso C, Andres A, Ferrero A, Roth A, Sperti E, Majno P, Rubbia-Brandt L. Reversibility of chemotherapy-related liver injury. J Hepatol 2017; 67:84-91. [PMID: 28284915 DOI: 10.1016/j.jhep.2017.02.031] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 02/18/2017] [Accepted: 02/20/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Chemotherapy-associated liver injury (CALI) increases the risk of liver resection and may prejudice further surgery and chemotherapy. The reversibility of CALI is therefore important; however, no data concerning this are available. This study aimed to retrospectively analyze the reversibility of CALI in patients undergoing liver resection for colorectal metastases. METHODS All resections of colorectal liver metastases after oxaliplatin and/or irinotecan-based chemotherapy were included. First, liver resections were stratified by time between end of chemotherapy and hepatectomy and several possible cut-off values tested. CALI prevalence in various groups was compared. Second, CALI in the two specimens from each patient who had undergone repeat liver resections without interval chemotherapy were compared. RESULTS Overall, 524 liver resections in 429 patients were analyzed. The median interval chemotherapy-surgery was 56days (15-1264). CALI prevalence did not differ significantly between groups with a chemotherapy-surgery interval <270days. Grade 2-3 sinusoidal dilatation (SOS, 19.4% vs. 40.0%, p=0.022) and nodular regenerative hyperplasia (NRH, 6.5% vs. 20.1%, p=0.063) occurred less frequently in patients with an interval >270days (n=31); prevalence of steatosis and steatohepatitis was similar in all groups. A chemotherapy-surgery interval >270days was an independent protector against Grade 2-3 SOS (p=0.009). Forty-seven patients had repeat liver resection without interval chemotherapy. CALI differed between surgeries only for a chemotherapy-surgery interval >270days (n=15), Grade 2-3 SOS having regressed in 4/5 patients and NRH in 7/8; whereas steatosis and steatohepatitis had persisted. CONCLUSIONS CALI persists for a long time after chemotherapy. SOS and NRH regress only after nine months without chemotherapy, whereas steatosis and steatohepatitis persist. LAY SUMMARY The patients affected by colorectal liver metastases often receive chemotherapy before liver resection, but chemotherapy causes liver injuries that may increase operative risks and reduce tolerance to further chemotherapy. The authors analyzed the reversibility of the liver injuries after the chemotherapy interruption. Liver injuries persist for a long time after chemotherapy. Sinusoidal dilatation and nodular regenerative hyperplasia regress only nine months after the end of chemotherapy, whereas steatosis and steatohepatitis persist even after this long interval.
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Affiliation(s)
- Luca Vigano
- Dept. of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Rozzano (MI), Italy.
| | - Giovanni De Rosa
- Dept. of Pathology, Ospedale Mauriziano Umberto I, Torino, Italy
| | - Christian Toso
- Dept. of Visceral and Transplantation Surgery, University Hospitals, Geneva, Switzerland; Hepato-Pancreato-Biliary Centre, University Hospitals, Geneva, Switzerland
| | - Axel Andres
- Dept. of Visceral and Transplantation Surgery, University Hospitals, Geneva, Switzerland; Hepato-Pancreato-Biliary Centre, University Hospitals, Geneva, Switzerland
| | - Alessandro Ferrero
- Dept. of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Torino, Italy
| | - Arnaud Roth
- Dept. of Oncology, University Hospitals, Geneva, Switzerland; Hepato-Pancreato-Biliary Centre, University Hospitals, Geneva, Switzerland
| | - Elisa Sperti
- Dept. of Oncology, Ospedale Mauriziano Umberto I, Torino, Italy
| | - Pietro Majno
- Dept. of Visceral and Transplantation Surgery, University Hospitals, Geneva, Switzerland; Hepato-Pancreato-Biliary Centre, University Hospitals, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Dept. of Clinical Pathology, Geneva, Switzerland; Hepato-Pancreato-Biliary Centre, University Hospitals, Geneva, Switzerland
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Giuliani J, Bonetti A. The Pharmacological Costs of Complete Liver Resections in Unselected Advanced Colorectal Cancer Patients: Focus on Targeted Agents. A Review of Randomized Clinical Trials. J Gastrointest Cancer 2017; 47:341-350. [PMID: 27488729 DOI: 10.1007/s12029-016-9862-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the pharmacological costs of conversion chemotherapy with targeted biological agents in an unselected population of advanced colorectal cancer (CRC) patients in order to achieve an R0 liver resection. METHODS Full reports and updates of randomized clinical trials (RCTs) that compared at least two front-line therapy regimens with targeted biological agents for advanced CRC patients were selected. The present evaluation was restricted to randomized phase II and III trials. The costs of drugs are at the Pharmacy Hospital and are expressed in euros (€). RESULTS Our study began with the evaluation of 683 abstracts. Forty-eight trials were considered appropriate for further analysis. A more in-depth evaluation looking for the trials reporting the liver resection rates following conversion chemotherapy brought to the exclusion of other 37 trials, leaving 11 randomized trials (three phase II trials, including 522 patients and eight phase III trials, including 7191 patients). The pharmacological costs of conversion therapy increased with the substitution of prolonged infusion 5-Fluorouracil by capecitabine and, to a much higher extent, with the introduction of biologicals. CONCLUSIONS Two key issues are presented in this review. First, the pharmacological costs of commonly used front line regimens based on the targeted biological agents for the treatment of advanced CRC are highly variable. Second, the performance of the published schemes, in terms of resection rates, depends on patient's selection, tumor characteristics, and on the type of the scheme.
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Affiliation(s)
- Jacopo Giuliani
- Department of Medical Oncology, Mater Salutis Hospital, AULSS 21 della Regione Veneto, Legnago, VR, Italy. .,Department of Medical Oncology, ASL 21 della Regione Veneto, Via Gianella 1, 37045, Legnago, VR, Italy.
| | - Andrea Bonetti
- Department of Medical Oncology, Mater Salutis Hospital, AULSS 21 della Regione Veneto, Legnago, VR, Italy.,Department of Medical Oncology, ASL 21 della Regione Veneto, Via Gianella 1, 37045, Legnago, VR, Italy
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Kim CW, Lee JL, Yoon YS, Park IJ, Lim SB, Yu CS, Kim TW, Kim JC. Resection after preoperative chemotherapy versus synchronous liver resection of colorectal cancer liver metastases: A propensity score matching analysis. Medicine (Baltimore) 2017; 96:e6174. [PMID: 28207557 PMCID: PMC5319546 DOI: 10.1097/md.0000000000006174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 01/28/2017] [Accepted: 01/30/2017] [Indexed: 12/14/2022] Open
Abstract
This study aimed to determine the prognostic effects of preoperative chemotherapy for colorectal cancer liver metastasis (CLM).We retrospectively evaluated 2 groups of patients between January 2006 and August 2012. A total of 53 patients who had ≥3 hepatic metastases underwent resection after preoperative chemotherapy (preoperative chemotherapy group), whereas 96 patients who had ≥3 hepatic metastases underwent resection with a curative intent before chemotherapy for CLM (primary resection group). A propensity score (PS) model was used to compare the both groups.The 3-year disease-free survival (DFS) rates were 31.7% and 20.4% in the preoperative chemotherapy and primary resection groups, respectively (log-rank = 0.015). Analyzing 32 PS matched pairs, we found that the DFS rate was significantly higher in the preoperative chemotherapy group than in the primary resection group (3-year DFS rates were 34.2% and 16.8%, respectively [log-rank = 0.019]). Preoperative chemotherapy group patients had better DFSs than primary resection group patients in various multivariate analyses, including crude, multivariable, average treatment effect with inverse probability of treatment weighting model and PS matching.Responses to chemotherapy are as important as achieving complete resection in cases of multiple hepatic metastases. Preoperative chemotherapy may therefore be preferentially considered for patients who experience difficulty undergoing complete resection for multiple hepatic metastases.
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Affiliation(s)
| | | | | | | | | | | | - Tae W. Kim
- Department of Medical Oncology, University of Ulsan College of Medicine, Institute of Innovative Cancer Research and Asan Medical Center, Seoul, Korea
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Buettner S, Koerkamp BG, Ejaz A, Buisman FE, Kim Y, Margonis GA, Alexandrescu S, Marques HP, Lamelas J, Aldrighetti L, Gamblin TC, Maithel SK, Pulitano C, Bauer TW, Shen F, Poultsides GA, Marsh JW, IJzermans JNM, Pawlik TM. The effect of preoperative chemotherapy treatment in surgically treated intrahepatic cholangiocarcinoma patients-A multi-institutional analysis. J Surg Oncol 2017; 115:312-318. [PMID: 28105651 DOI: 10.1002/jso.24524] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/30/2016] [Accepted: 11/21/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION While preoperative chemotherapy (pCT) is utilized in many intra-abdominal cancers, the use of pCT among patients with intrahepatic cholangiocarcinoma (ICC) remains ill defined. As such, the objective of the current study was to examine the impact of pCT among patients undergoing curative-intent resection for ICC. METHODS Patients who underwent hepatectomy for ICC were identified from a multi-institutional international cohort. The association between pCT with peri-operative and long-term clinical outcomes was assessed. RESULTS Of the 1 057 patients who were identified and met the inclusion criteria, 62 patients (5.9%) received pCT. These patients were noticed to have more advanced disease. Median OS (pCT:46.9 months vs no pCT:37.4 months; P = 0.900) and DFS (pCT: 34.1 months vs no pCT: 29.1 months; P = 0.909) were similar between the two groups. In a subgroup analysis of propensity-score matched patients, there was longer OS (pCT:46.9 months vs no pCT:29.4 months) and DFS (pCT:34.1 months vs no pCT:14.0 months); however this did not reach statistical significance (both P > 0.05). CONCLUSION In conclusion, pCT utilization among patients with ICC was higher among patients with more advanced disease. Short-term post-operative outcomes were not affected by pCT use and receipt of pCT resulted in equivalent OS and DFS following curative-intent resection.
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Affiliation(s)
- Stefan Buettner
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.,Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Aslam Ejaz
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Florian E Buisman
- Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yuhree Kim
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | - Todd W Bauer
- University of Virginia, Charlottesville, Virginia
| | - Feng Shen
- Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | | | - J Wallis Marsh
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jan N M IJzermans
- Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Timothy M Pawlik
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
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Huo YR, Shiraev T, Alzahrani N, Chu F. Reducing inflow occlusion, occlusion duration and blood loss during hepatic resections. ANZ J Surg 2016; 88:E25-E29. [PMID: 27788559 DOI: 10.1111/ans.13711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND To assess the changes in blood loss during hepatic resection with improved haemostatic devices such as a bipolar sealing device and a topical haemostatic agent. METHODS This retrospective clinical study of prospectively collected data will assess hepatic resections performed by a single surgeon between 2005 and 2013, with the introduction of the two haemostatic techniques in 2009. RESULTS A total of 371 hepatic resections (214 from 2005 to 2008 and 157 from 2009 to 2013) were included in this study. Compared with the conventional hepatic resection (2005-2008), the use of haemostatic techniques (2009-2013) significantly reduced the need for inflow occlusion (OR: 0.37, 95% CI: 0.24-0.57, P < 0.001), overall occlusion time (20.8 min versus 25.9 min, P = 0.04) and transfusion requirement (4.6% versus 12%, OR: 0.35, 95% CI: 0.14-0.90, P = 0.02). Mean overall blood loss was reduced post-2009; however, the decrease was not statistically different (401.3 mL versus 470.8 mL, P = 0.27). Subgroup analysis revealed that blood loss was more than halved post-2009 compared with pre-2009 for patients who received pre-operative chemotherapy (324.6 mL versus 738.5 mL, P = 0.005). CONCLUSION The use of a bipolar sealing device and a topical haemostatic agent reduces the need for inflow occlusion, overall occlusion time and transfusions in all patients compared with conventional hepatic resections.
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Affiliation(s)
- Ya Ruth Huo
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Tim Shiraev
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Nayef Alzahrani
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Francis Chu
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
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Nagayama S, Hasegawa S, Hida K, Kawada K, Hatano E, Nakamura K, Seo S, Taura K, Yasuchika K, Matsuo T, Zaima M, Kanazawa A, Terajima H, Tada M, Adachi Y, Nishitai R, Manaka D, Yoshimura T, Doi K, Horimatsu T, Mitsuyoshi A, Yoshimura K, Niimi M, Matsumoto S, Sakai Y, Uemoto S. Multi-institutional phase II study on the feasibility of liver resection following preoperative mFOLFOX6 therapy for resectable liver metastases from colorectal cancers. Int J Clin Oncol 2016; 22:316-323. [DOI: 10.1007/s10147-016-1050-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/04/2016] [Indexed: 01/17/2023]
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28
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Egger ME, Gottumukkala V, Wilks JA, Soliz J, Ilmer M, Vauthey JN, Conrad C. Anesthetic and operative considerations for laparoscopic liver resection. Surgery 2016; 161:1191-1202. [PMID: 27545995 DOI: 10.1016/j.surg.2016.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/06/2016] [Accepted: 07/09/2016] [Indexed: 02/06/2023]
Abstract
We enumerate the broad range of anesthetic considerations that affect the outcome of patients undergoing laparoscopic liver resection. Key elements for excellent outcomes after laparoscopic liver resection are careful patient selection and risk stratification, appropriate monitoring, techniques to reduce blood loss and transfusion, and active recovery management. Although some of these key elements are the same for open liver operation, there are specific anesthetic considerations of which both the surgical and anesthesia teams must be aware to achieve optimal patient outcomes after laparoscopic liver resection. While unique advantages of laparoscopic liver resection typically include decreased intraoperative bleeding, transfusion requirements, and a lower incidence of postoperative ascites, specific challenges include management of the complicated interplay between low-volume anesthesia and increased intraabdominal pressure due to pneumoperitoneum, with additional considerations regarding circulatory support to treat acute blood loss with need for emergent conversion in some cases. This article will address in detail the preoperative, intraoperative, and postoperative anesthetic considerations for patients undergoing laparoscopic liver resection that both the surgical and anesthesia team should be aware of to optimize outcomes.
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Affiliation(s)
- Michael E Egger
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jonathan A Wilks
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jose Soliz
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthias Ilmer
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jean Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Claudius Conrad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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29
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Jones RP, Malik HZ, Fenwick SW, Terlizzo M, O'Grady E, Stremitzer S, Gruenberger T, Rees M, Plant G, Figueras J, Albiol M, Adam R, Awad S, Poston GJ. PARAGON II - A single arm multicentre phase II study of neoadjuvant therapy using irinotecan bead in patients with resectable liver metastases from colorectal cancer. Eur J Surg Oncol 2016; 42:1866-1872. [PMID: 27561844 DOI: 10.1016/j.ejso.2016.07.142] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/27/2016] [Accepted: 07/30/2016] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Perioperative chemotherapy confers a 3-year progression free survival advantage following resection of colorectal liver metastases (CRLM), but is associated with significant toxicity. Chemoembolisation using drug eluting PVA microspheres loaded with irinotecan (DEBIRI) allows sustained delivery of drug directly to tumour, maximising response whilst minimising systemic exposure. This phase II single arm study examined the safety and feasibility of DEBIRI before resection of CRLM. METHODS Patients with resectable CRLM received lobar DEBIRI 1 month prior to surgery, with a radiological endpoint of near stasis. The trial had a primary end-point of tumour resectability (R0 resection). Secondary end-points included safety, pathologic tumour response and overall survival. RESULTS 40 patients received DEBIRI, with a median dose of 103 mg irinotecan (range 64-175 mg). Morbidity was low (2.5%, CTCAE grade 2) with no evidence of systemic chemotoxicity. All patients proceeded to surgery, with 38 undergoing resection (95%, R0 resection rate 74%). 30-day post-operative mortality was 5% (n = 2), with neither death TACE related. 66 lesions were resected, with histologic major or complete pathologic response seen in 77.3% of targeted lesions. At median follow up of 40.6 months, 12 patients (34.3%) had died of recurrent disease with a median overall survival of 50.9 months. Nominal 1, 3 and 5-year OS was 93, 78 & 49% respectively. CONCLUSIONS Resection after neoadjuvant DEBIRI for CRLM is feasible and safe. Single treatment with DEBIRI resulted in tumour pathologic response and median overall survival comparable to that seen after systemic neoadjuvant chemotherapy. Registered at clinicaltrials.gov (NCT00844233).
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Affiliation(s)
- R P Jones
- School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK.
| | - H Z Malik
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
| | - S W Fenwick
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
| | - M Terlizzo
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
| | - E O'Grady
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
| | | | | | - M Rees
- Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - G Plant
- Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - J Figueras
- Dr. Josep Trueta Hospital, Institut d'Investigacions Biomediques de Girona (IdIBGi), Girona, Spain
| | - M Albiol
- Dr. Josep Trueta Hospital, Institut d'Investigacions Biomediques de Girona (IdIBGi), Girona, Spain
| | - R Adam
- Hôpital Universitaire Paul Brousse, Unité Inserm U935, Université Paris Sud, Villejuif, France
| | - S Awad
- Hôpital Universitaire Paul Brousse, Unité Inserm U935, Université Paris Sud, Villejuif, France
| | - G J Poston
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
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Nishioka Y, Shindoh J, Yoshioka R, Gonoi W, Abe H, Okura N, Yoshida S, Oba M, Hashimoto M, Watanabe G, Hasegawa K, Kokudo N. Radiological Morphology of Colorectal Liver Metastases after Preoperative Chemotherapy Predicts Tumor Viability and Postoperative Outcomes. J Gastrointest Surg 2015; 19:1653-1661. [PMID: 25917536 DOI: 10.1007/s11605-015-2836-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 04/20/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The computed tomography (CT) morphology after chemotherapy is reportedly correlated with the histopathologic response to chemotherapy and a better surgical outcome in patients with colorectal liver metastases (CLM). However, the true prognostic advantage of CT morphology remains uncertain. METHODS The prognostic advantage of CT morphology was validated in 86 patients who underwent surgical resection for CLM after undergoing a 5-fluorouracil-based chemotherapy regimen with or without bevacizumab. RESULTS An optimal morphologic response was observed in 18 (22.8%) patients, and a strong correlation between the CT morphology and tumor viability was confirmed (P < 0.001). A multivariate analysis revealed that bevacizumab (odds ratio [OR], 6.8; P = 0.03) and chemotherapy cycles ≥6 (OR, 3.6; P = 0.04) were associated with an optimal morphologic response. Overall survival (OS) and recurrence-free survival (RFS) were also predicted by CT morphology with a higher sensitivity. Particularly, a group 1 morphology was associated with a higher OS rate (3-year OS 100%) and RFS rate (3-year RFS, 57.0%), and a multivariate analysis confirmed that group 2 and group 3 tumor morphology was a significant predictive factor for tumor recurrence (hazard ratio [HR], 2.5; P = 0.03 and HR, 3.2; P < 0.01, respectively). CONCLUSION The CT morphology of CLM predicts tumor viability and long-term surgical outcomes after chemotherapy.
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Affiliation(s)
- Yujiro Nishioka
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Truant S, Séquier C, Leteurtre E, Boleslawski E, Elamrani M, Huet G, Duhamel A, Hebbar M, Pruvot FR. Tumour biology of colorectal liver metastasis is a more important factor in survival than surgical margin clearance in the era of modern chemotherapy regimens. HPB (Oxford) 2015; 17:176-84. [PMID: 25041611 PMCID: PMC4299392 DOI: 10.1111/hpb.12316] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/04/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of the authors was to reassess the impact of a positive surgical margin (R1) after a liver resection for colorectal liver metastases (CLMs) on survival in the era of modern chemotherapy, through their own experience and a literature review. METHODS Inclusion criteria were: R1 or R0 resection with no local treatment modalities, extra-hepatic metastases or other cancer. RESULTS Among 337 patients operated between 2000 and 2010, 273 patients were eligible (214 R0/59 R1). The mean follow-up was 43 ± 29 months. Compared with a R0 resection, a R1 resection offered a lower 5-year overall (39.1% versus 54.2%, P = 0.010), disease-free (15.2% versus 31.1%, P = 0.021) and progression-free (i.e. time to the first non-curable recurrence; 33.1% versus 47.3%, P = 0.033) survival rates. Metastases in the R1 group were more numerous, larger and more frequently synchronous. Independent factors of poor survival were: number, size and short-time interval of CLM occurrence, N status, rectal primary, absence of adjuvant chemotherapy, but not a R1 resection. With the more-systematic administration of chemotherapy since 2005, the intergroup difference in progression-free survival disappeared (P = 0.264). CONCLUSION A R1 resection had no prognostic value per se but reflected a more severe disease. The recent change in the prognostic value of a R1 resection may be linked to the beneficial effect of chemotherapy.
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Affiliation(s)
- Stéphanie Truant
- Department of Digestive Surgery and Transplantation, Lille University Medical Center, University of Lille Nord de FranceLille, France
| | - Cédric Séquier
- Department of Digestive Surgery and Transplantation, Lille University Medical Center, University of Lille Nord de FranceLille, France
| | - Emmanuelle Leteurtre
- Department of Pathology, Lille University Medical Center, University of Lille Nord de FranceLille, France
| | - Emmanuel Boleslawski
- Department of Digestive Surgery and Transplantation, Lille University Medical Center, University of Lille Nord de FranceLille, France
| | - Mehdi Elamrani
- Department of Digestive Surgery and Transplantation, Lille University Medical Center, University of Lille Nord de FranceLille, France
| | - Guillemette Huet
- Department of Medical Oncology, Lille University Medical Center, University of Lille Nord de FranceLille, France
| | - Alain Duhamel
- INSERM U837, Lille 2 University, Jean-Pierre Aubert Centre, University of Lille Nord de FranceLille, France
| | - Mohamed Hebbar
- Department of Statistics, Lille University Medical Center, University of Lille Nord de FranceLille, France
| | - François-René Pruvot
- Department of Digestive Surgery and Transplantation, Lille University Medical Center, University of Lille Nord de FranceLille, France
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Wakiya T, Kudo D, Toyoki Y, Ishido K, Kimura N, Narumi S, Kijima H, Hakamada K. Evaluation of the usefulness of the indocyanine green clearance test for chemotherapy-associated liver injury in patients with colorectal cancer liver metastasis. Ann Surg Oncol 2014; 21:167-72. [PMID: 23959055 DOI: 10.1245/s10434-013-3203-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND The indocyanine green (ICG) clearance test is reported to be useful for the preoperative evaluation of hepatic functional reserve. However, the ICG clearance test has not been sufficiently investigated in patients with colorectal liver metastasis after chemotherapy. The aim of the present study was to evaluate whether the ICG clearance test is a useful parameter for the preoperative detection of chemotherapy-associated liver injury. METHODS Ninety-four patients undergoing liver resection for colorectal liver metastasis after chemotherapy were studied. The medical records for each case were retrospectively reviewed. They underwent pathological assessment to clarify the degree of histopathological liver injury of the nontumoral liver parenchyma. In addition, the correlation between the pathological score and the ICG retention rate at 15 min (ICG-R15) was analyzed. RESULTS Sinusoidal injury was observed in the 31 of 94 patients. Steatohepatitis was observed in the 40 of 94 patients. There was no strong correlation between the preoperative ICG-R15 value and the sinusoidal pathological score (r = 0.117, P = 0.261). There was no strong correlation between the ICG-R15 and the nonalcoholic fatty liver disease activity score (r = 0.215, P = 0.037). CONCLUSIONS It was difficult to predict the degree of chemotherapy-associated liver injury by the preoperative ICG-R15 value. It is necessary to estimate the hepatic functional reserve based on a combination of several clinical indicators without relying on the ICG test, in order to perform a safe radical liver resection.
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Pandanaboyana S, White A, Pathak S, Hidalgo EL, Toogood G, Lodge JP, Prasad KR. Impact of margin status and neoadjuvant chemotherapy on survival, recurrence after liver resection for colorectal liver metastasis. Ann Surg Oncol 2014; 22:173-9. [PMID: 25084766 DOI: 10.1245/s10434-014-3953-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study was designed to determine the impact of positive margin and neoadjuvant chemotherapy (NAC) on recurrence and survival after resection of colorectal liver metastasis (CRLM). METHODS Prospective analysis of 1,255 patients undergoing resection of CLRM was undertaken. The impact of NAC, site of recurrence, and survival between R0 and R1 groups was analysed. RESULTS The R0 and R1 resection rates were 68.9 % (n = 865) and 31.1 % (390). The median OS for R0 group was 2.7 years (95 % CI 2.56-2.85) and R1 group 2.28 years (CI 2.06-2.52; P < 0.001). The median DFS for R0 group was 1.52 years (CI 1.38-1.66) and R1 group 1.04 years (CI 0.94-1.19; P < 0.001). The intrahepatic recurrence was higher in R1 group 132 (33.8 %) versus 142 (16.4 %) [P = 0.0001]. A total of 103 (11.9 %) patients in R0 group underwent redo liver resection for recurrence compared with 66 (16.9 %) patients in R1 group (P = 0.016). NAC did not impact recurrence rate (57.8 % vs. 61.5 %, P = 0.187) and redo liver surgery between R0 and R1 groups (13 % vs. 17 %, P = 0.092). Within the R1 group, the intrahepatic recurrence rates were similar with and without NAC (33.9 % vs. 33.7 %, P = 0.669). However, DFS was longer in the no chemotherapy group than the chemotherapy group. CONCLUSIONS R1 resections increase the likelihood of recurrence in the liver and redo liver surgery. NAC does not seem to improve survival in margin positive patients or have an impact on recurrence or reduce need for redo liver surgery for recurrence. In patients with R1 resection, neoadjuvant chemotherapy may have adverse outcome on disease free survival.
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Affiliation(s)
- Sanjay Pandanaboyana
- Department of HPB and Transplant Surgery, St James's University Hospital NHS Trust, West Yorkshire, UK,
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Reissfelder C, Brand K, Sobiegalla J, Rahbari NN, Bork U, Schirmacher P, Büchler MW, Weitz J, Koch M. Chemotherapy-associated liver injury and its influence on outcome after resection of colorectal liver metastases. Surgery 2013; 155:245-54. [PMID: 24314883 DOI: 10.1016/j.surg.2013.07.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 07/01/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND Advances in neoadjuvant therapy enabled novel strategies for treating resectable and initially unresectable colorectal cancer liver metastases. Although it is well known that chemotherapeutic agents cause certain types of liver parenchymal injury, the actual contribution of chemotherapy-associated hepatotoxicity to postoperative morbidity remains poorly defined. The aim of this study was to define all kinds of chemotherapy-associated liver injury and to examine its impact on postoperative morbidity. PATIENTS AND METHODS We included 119 patients who were treated between 2002 and 2010. Chemotherapy-associated changes of the liver were subclassified in 11 different categories and correlated with postoperative morbidity with the ultimate aim of generating a liver injury risk score. RESULTS On univariate analysis severity (P = .004) and localization of parenchymal inflammation (P = .04) were associated with morbidity. Steatosis did not correlate with postoperative outcome (P = .69), whereas steatohepatitis (as assessed by the nonalcoholic fatty liver disease activity score score) was related with morbidity (P = .03). On multivariate analysis, the severity of inflammation (95% confidence interval, 1.008-6.526; odds ratio, 2.56; P = .04) was significantly correlated with postoperative morbidity. The newly developed liver injury risk score was highly associated with postoperative complications (P = .006). CONCLUSION In this study, the induction of inflammation by conventional chemotherapy and its relevance for the development of clinical complications could be demonstrated. The proposed risk score for liver injury-related morbidity might help to better select patients eligible for an operation.
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Affiliation(s)
- Christoph Reissfelder
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; Department of Visceral, Thoracic and Vascular Surgery, University of Dresden, Dresden, Germany.
| | - Karsten Brand
- Department of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Julia Sobiegalla
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Nuh N Rahbari
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Bork
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; Department of Visceral, Thoracic and Vascular Surgery, University of Dresden, Dresden, Germany
| | - Peter Schirmacher
- Department of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jürgen Weitz
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; Department of Visceral, Thoracic and Vascular Surgery, University of Dresden, Dresden, Germany
| | - Moritz Koch
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; Department of Visceral, Thoracic and Vascular Surgery, University of Dresden, Dresden, Germany
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Reeves JG, Suriawinata AA, Ng DP, Holubar SD, Mills JB, Barth RJ. Short-term preoperative diet modification reduces steatosis and blood loss in patients undergoing liver resection. Surgery 2013; 154:1031-7. [DOI: 10.1016/j.surg.2013.04.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 04/04/2013] [Indexed: 01/11/2023]
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Influence of Preoperative Chemotherapy on CT Volumetric Liver Regeneration Following Right Hemihepatectomy. World J Surg 2013; 38:497-504. [DOI: 10.1007/s00268-013-2278-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Novel Prediction Score Including Pre- and Intraoperative Parameters Best Predicts Acute Kidney Injury after Liver Surgery. World J Surg 2013; 37:2618-28. [DOI: 10.1007/s00268-013-2159-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Scuderi MG, Magro G, Di Cataldo A, Pesce A, Scalora L, Vecchio GM, Portale R, Di Benedetto V, Puleo S. Evaluation of neoadjuvant chemotherapy effects on liver parenchyma in resected pediatric malignancies. Pediatr Hematol Oncol 2013; 30:392-399. [PMID: 23594333 DOI: 10.3109/08880018.2013.788592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Neoadjuvant chemotherapy for colorectal liver metastases in adults is responsible for chemotherapy-associated liver injury (CALI), characterized by steatosis, steatohepatitis, and sinusoidal obstruction syndrome. These alterations cause delayed operation to reduce the risk of hemorrhage, portal hypertension, and hepatic failure. Children with hepatic malignancies usually receive neoadjuvant chemotherapy prior to surgery. The aim of this study was to evaluate retrospectively whether the CALI occurs in this pediatric population. This study evaluated patients referred since 1996 for hepatic malignancies who received hepatectomy after chemotherapy. Liver resection material was reviewed, in order to investigate the presence of morphological changes compatible with the CALI in the peritumoral hepatic tissue. Twelve patients were recruited. All patients satisfied the inclusion criteria except one who did not receive neoadjuvant chemotherapy. Eleven children underwent surgery 1 month after the last chemotherapy cycle. All are alive disease-free. Histological examination of specimen revealed only mild changes such as diffuse swelling of hepatocytes and focal, mild portal inflammation. Severe hepatic changes such as steatosis, necrosis, or fibrosis were not identified. CALI-related morphological changes were not found in our patients. The absence of the CALI could be attributed to the younger age of patients (possible different response to stress) and/or to the different chemotherapy schedules compared to those in use for adults patients.
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Jones R, Malik H, Fenwick S, Poston G. Perioperative chemotherapy for resectable colorectal liver metastases: Where now? Eur J Surg Oncol 2013; 39:807-11. [DOI: 10.1016/j.ejso.2013.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 11/27/2012] [Accepted: 04/25/2013] [Indexed: 12/28/2022] Open
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Aliyev S, Agcaoglu O, Aksoy E, Taskin HE, Vogt D, Fung J, Siperstein A, Berber E. Efficacy of laparoscopic radiofrequency ablation for the treatment of patients with small solitary colorectal liver metastasis. Surgery 2013; 154:556-62. [PMID: 23859307 DOI: 10.1016/j.surg.2013.03.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 03/25/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although radiofrequency ablation (RFA) has been incorporated to the treatment algorithm of patients with unresectable colorectal liver metastasis (CLM), its utility in patients with resectable disease has not been well studied. The aims of this study were to define the clinical profile of patients with a solitary CLM who underwent laparoscopic RFA and to analyze their oncologic outcomes. METHODS Between 2000 and 2011, 44 patients underwent laparoscopic RFA and 60 patients resection of solitary CLM ≤3 cm. Data were analyzed from a prospectively maintained institutional review board-approved database using Student's t test, Chi-square, and Kaplan-Meier tests. RESULTS The indications for RFA were patient decision in 61% (n = 27), comorbidities in 34% (n = 15), and intraoperative findings in 5% (n = 2). In comparison with the resection group, RFA patients had a greater American Society of Anesthesiologists score (3.0 ± 0.1 vs 2.6 ± 0.1, respectively; P = .002), more frequent incidence of cardiopulmonary comorbidities (60% vs 38%, respectively; P = .045), and tumors located deeper in the liver parenchyma (39% vs 12%) that would have required a formal lobectomy. The 2 groups were otherwise similar for age, gender, carcinoembrradyogenic antigen, synchronous versus metachronous presentation of CLM, tumor size, and tumor and nodal status of primary colorectal cancer. The local recurrence rate was 18% after RFA and 4% after resection (P = .012). The overall Kaplan-Meier, cancer-specific, 5-year survival was 47% for RFA and 57% for resection (P = .464). Median disease-free survival was 25 months after RFA and 22 months after resection (P = .973). CONCLUSION Our results suggest that laparoscopic RFA might spare a number of patients at greater risk with a small solitary CLM the risk of morbidity from a formal liver resection. Furthermore, laparoscopic RFA might also be acceptable as the first line of therapy for patients with tumors that otherwise would have required a formal lobectomy or open resection. Nevertheless, the local recurrence rate of RFA should be kept in mind and the patients followed closely to treat failures promptly.
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Affiliation(s)
- Shamil Aliyev
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Jones C, Kelliher L, Bigham C, Quiney N. Acute Liver Failure following Hepatic Resection: Incidence, Presentation, Prevention and Management in ICU. J Intensive Care Soc 2013. [DOI: 10.1177/175114371301400211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence of liver failure following liver resection has been reported to be between 8–32%, depending on the number of segments resected, the health of the patient and the incidence of hepatic ischaemic/reperfusion injury. This article outlines the evidence surrounding classification, prevention and management of this condition.
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Affiliation(s)
| | | | - Colin Bigham
- Locum Consultant in Anaesthesia and Intensive Care
| | - Nial Quiney
- Consultant in Anaesthesia and Intensive Care Royal Surrey County Hospital NHS Foundation Trust
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Shindoh J, Loyer EM, Kopetz S, Boonsirikamchai P, Maru DM, Chun YS, Zimmitti G, Curley SA, Charnsangavej C, Aloia TA, Vauthey JN. Optimal morphologic response to preoperative chemotherapy: an alternate outcome end point before resection of hepatic colorectal metastases. J Clin Oncol 2012; 30:4566-4572. [PMID: 23150701 PMCID: PMC3518730 DOI: 10.1200/jco.2012.45.2854] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 09/17/2012] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The purposes of this study were to confirm the prognostic value of an optimal morphologic response to preoperative chemotherapy in patients undergoing chemotherapy with or without bevacizumab before resection of colorectal liver metastases (CLM) and to identify predictors of the optimal morphologic response. PATIENTS AND METHODS The study included 209 patients who underwent resection of CLM after preoperative chemotherapy with oxaliplatin- or irinotecan-based regimens with or without bevacizumab. Radiologic responses were classified as optimal or suboptimal according to the morphologic response criteria. Overall survival (OS) was determined, and prognostic factors associated with an optimal response were identified in multivariate analysis. RESULTS An optimal morphologic response was observed in 47% of patients treated with bevacizumab and 12% of patients treated without bevacizumab (P < .001). The 3- and 5-year OS rates were higher in the optimal response group (82% and 74%, respectively) compared with the suboptimal response group (60% and 45%, respectively; P < .001). On multivariate analysis, suboptimal morphologic response was an independent predictor of worse OS (hazard ratio, 2.09; P = .007). Receipt of bevacizumab (odds ratio, 6.71; P < .001) and largest metastasis before chemotherapy of ≤ 3 cm (odds ratio, 2.12; P = .025) were significantly associated with optimal morphologic response. The morphologic response showed no specific correlation with conventional size-based RECIST criteria, and it was superior to RECIST in predicting major pathologic response. CONCLUSION Independent of preoperative chemotherapy regimen, optimal morphologic response is sufficiently correlated with OS to be considered a surrogate therapeutic end point for patients with CLM.
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Affiliation(s)
- Junichi Shindoh
- Junichi Shindoh, Evelyne M. Loyer, Scott Kopetz, Piyaporn Boonsirikamchai, Dipen M. Maru, Giuseppe Zimmitti, Steven A. Curley, Chusilp Charnsangavej, Thomas A. Aloia, and Jean-Nicolas Vauthey, The University of Texas MD Anderson Cancer Center, Houston, TX; Yun Shin Chun, Fox Chase Cancer Center, Philadelphia, PA
| | - Evelyne M. Loyer
- Junichi Shindoh, Evelyne M. Loyer, Scott Kopetz, Piyaporn Boonsirikamchai, Dipen M. Maru, Giuseppe Zimmitti, Steven A. Curley, Chusilp Charnsangavej, Thomas A. Aloia, and Jean-Nicolas Vauthey, The University of Texas MD Anderson Cancer Center, Houston, TX; Yun Shin Chun, Fox Chase Cancer Center, Philadelphia, PA
| | - Scott Kopetz
- Junichi Shindoh, Evelyne M. Loyer, Scott Kopetz, Piyaporn Boonsirikamchai, Dipen M. Maru, Giuseppe Zimmitti, Steven A. Curley, Chusilp Charnsangavej, Thomas A. Aloia, and Jean-Nicolas Vauthey, The University of Texas MD Anderson Cancer Center, Houston, TX; Yun Shin Chun, Fox Chase Cancer Center, Philadelphia, PA
| | - Piyaporn Boonsirikamchai
- Junichi Shindoh, Evelyne M. Loyer, Scott Kopetz, Piyaporn Boonsirikamchai, Dipen M. Maru, Giuseppe Zimmitti, Steven A. Curley, Chusilp Charnsangavej, Thomas A. Aloia, and Jean-Nicolas Vauthey, The University of Texas MD Anderson Cancer Center, Houston, TX; Yun Shin Chun, Fox Chase Cancer Center, Philadelphia, PA
| | - Dipen M. Maru
- Junichi Shindoh, Evelyne M. Loyer, Scott Kopetz, Piyaporn Boonsirikamchai, Dipen M. Maru, Giuseppe Zimmitti, Steven A. Curley, Chusilp Charnsangavej, Thomas A. Aloia, and Jean-Nicolas Vauthey, The University of Texas MD Anderson Cancer Center, Houston, TX; Yun Shin Chun, Fox Chase Cancer Center, Philadelphia, PA
| | - Yun Shin Chun
- Junichi Shindoh, Evelyne M. Loyer, Scott Kopetz, Piyaporn Boonsirikamchai, Dipen M. Maru, Giuseppe Zimmitti, Steven A. Curley, Chusilp Charnsangavej, Thomas A. Aloia, and Jean-Nicolas Vauthey, The University of Texas MD Anderson Cancer Center, Houston, TX; Yun Shin Chun, Fox Chase Cancer Center, Philadelphia, PA
| | - Giuseppe Zimmitti
- Junichi Shindoh, Evelyne M. Loyer, Scott Kopetz, Piyaporn Boonsirikamchai, Dipen M. Maru, Giuseppe Zimmitti, Steven A. Curley, Chusilp Charnsangavej, Thomas A. Aloia, and Jean-Nicolas Vauthey, The University of Texas MD Anderson Cancer Center, Houston, TX; Yun Shin Chun, Fox Chase Cancer Center, Philadelphia, PA
| | - Steven A. Curley
- Junichi Shindoh, Evelyne M. Loyer, Scott Kopetz, Piyaporn Boonsirikamchai, Dipen M. Maru, Giuseppe Zimmitti, Steven A. Curley, Chusilp Charnsangavej, Thomas A. Aloia, and Jean-Nicolas Vauthey, The University of Texas MD Anderson Cancer Center, Houston, TX; Yun Shin Chun, Fox Chase Cancer Center, Philadelphia, PA
| | - Chusilp Charnsangavej
- Junichi Shindoh, Evelyne M. Loyer, Scott Kopetz, Piyaporn Boonsirikamchai, Dipen M. Maru, Giuseppe Zimmitti, Steven A. Curley, Chusilp Charnsangavej, Thomas A. Aloia, and Jean-Nicolas Vauthey, The University of Texas MD Anderson Cancer Center, Houston, TX; Yun Shin Chun, Fox Chase Cancer Center, Philadelphia, PA
| | - Thomas A. Aloia
- Junichi Shindoh, Evelyne M. Loyer, Scott Kopetz, Piyaporn Boonsirikamchai, Dipen M. Maru, Giuseppe Zimmitti, Steven A. Curley, Chusilp Charnsangavej, Thomas A. Aloia, and Jean-Nicolas Vauthey, The University of Texas MD Anderson Cancer Center, Houston, TX; Yun Shin Chun, Fox Chase Cancer Center, Philadelphia, PA
| | - Jean-Nicolas Vauthey
- Junichi Shindoh, Evelyne M. Loyer, Scott Kopetz, Piyaporn Boonsirikamchai, Dipen M. Maru, Giuseppe Zimmitti, Steven A. Curley, Chusilp Charnsangavej, Thomas A. Aloia, and Jean-Nicolas Vauthey, The University of Texas MD Anderson Cancer Center, Houston, TX; Yun Shin Chun, Fox Chase Cancer Center, Philadelphia, PA
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Timing of two-stage liver resection during chemotherapy for otherwise unresectable colorectal metastases. World J Surg 2012; 36:1832-41. [PMID: 22484568 DOI: 10.1007/s00268-012-1578-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Tumor downsizing by effective chemotherapy while increasing remnant liver volume by two-stage hepatectomy can expand eligibility for resection of otherwise unresectable liver metastases. However, optimal timing of two-stage hepatectomy with respect to chemotherapy is undetermined. METHODS We retrospectively analyzed the effect of timing of two-stage hepatectomy and chemotherapy using data from 95 patients whose colorectal liver metastases initially were considered unresectable. RESULTS In 21 of 22 (95 %) patients whose first liver resection preceded chemotherapy (Hx-CTx group) and in 39 of 73 (53 %) patients whose chemotherapy preceded surgery (CTx-Hx group), macroscopic complete resection ultimately was achieved (P < 0.01). Overall and disease-free survivals were comparable between groups. However, overall survival of patients not achieving complete resection in the CTx-Hx group was significantly poorer than that for patients achieving complete resection (P < 0.01). When the 21 patients with complete resection in the Hx-CTx group were compared to the 39 patients with complete resection in the CTx-Hx group, no difference in overall or disease-free survival was observed (P = 0.12 and P = 0.24, respectively), although poor response to chemotherapy was more frequent in the Hx-CTx group. CONCLUSIONS Optimal timing of hepatectomy and chemotherapy is difficult to specify, but performing the initial resection in a two-stage hepatectomy before chemotherapy may increase likelihood of macroscopic complete resection, even in patients with a poor response to chemotherapy or with limited courses of chemotherapy.
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Nanji S, Cleary S, Ryan P, Guindi M, Selvarajah S, Al-Ali H, Grieg P, McGilvary I, Taylor B, Wei A, Moulton CA, Gallinger S. Up-front hepatic resection for metastatic colorectal cancer results in favorable long-term survival. Ann Surg Oncol 2012; 20:295-304. [PMID: 23054102 DOI: 10.1245/s10434-012-2424-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatic metastasis from colorectal cancer (CRC) is best managed with a multimodal approach; however, the optimal timing of liver resection in relation to administration of perioperative chemotherapy remains unclear. Our strategy has been to offer up-front liver resection for patients with resectable hepatic metastases, followed by post-liver resection chemotherapy. We report the outcomes of patients based on this surgical approach. METHODS A retrospective review of all patients undergoing liver resection for CRC metastases over a 5-year period (2002-2007) was performed. Associations between clinicopathologic factors and survival were evaluated by the Cox proportional hazard method. RESULTS A total of 320 patients underwent 336 liver resections. Median follow-up was 40 (range 8-80) months. The majority (n=195, 60.9%) had metachronous disease, and most patients (n=286, 85%) had a major hepatectomy (>3 segments). Thirty-six patients (11%) received preoperative chemotherapy, predominantly for downstaging unresectable disease. Ninety-day mortality was 2.1%, and perioperative morbidity occurred in 68 patients (20.2%). Actual disease-free survival at 3 and 5 years was 46.2% and 42%, respectively. Actual overall survival (OS) at 3 and 5 years was 63.7% and 55%, respectively. Multivariate analysis identified four factors that were independently associated with differences in OS (hazard ratio; 95% confidence interval): size of metastasis>6 cm (2.2; 1.3-3.5), positive lymph node status of the primary CRC (N1 (2.0; 1.0-3.8), N2 (2.4; 1.2-4.9)), synchronous disease (2.1; 1.3-3.5), and treatment with chemotherapy after liver resection (0.42; 0.23-0.75). CONCLUSIONS Up-front surgery for patients with resectable CRC liver metastases, followed by chemotherapy, can lead to favorable OS.
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Affiliation(s)
- Sulaiman Nanji
- Department of Surgery, Queen's University, Kingston, ON, Canada
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Filicori F, Keutgen XM, Zanello M, Ercolani G, Di Saverio S, Sacchetti F, Pinna AD, Grazi GL. Prognostic criteria for postoperative mortality in 170 patients undergoing major right hepatectomy. Hepatobiliary Pancreat Dis Int 2012; 11:507-12. [PMID: 23060396 DOI: 10.1016/s1499-3872(12)60215-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Postoperative hepatic failure is a dreadful complication after major hepatectomy and carries high morbidity and mortality rates. In this study, we assessed the accuracy of the 50/50 criteria (bilirubin >2.9 mg/dL and international normalized ratio >1.7 on postoperative day 5) and the Mullen criteria (bilirubin peak >7 mg/dL on postoperative days 1-7) in predicting death from hepatic failure in patients undergoing right hepatectomy only. In addition, we identified prognostic factors linked to intra-hospital morbidity and mortality in these patients. METHODS One hundred seventy consecutive patients underwent major right hepatectomy at a tertiary medical center from 2000 to 2008. Nineteen (11.2%) patients suffered from liver cirrhosis. Univariate and multivariate analyses were performed to identify predictors of intra-hospital mortality, morbidity and death from hepatic failure. RESULTS The intra-hospital mortality was 6.5% (11/170). Of the six patients who died from hepatic failure, one was positive for the 50/50 criteria, but all six patients were positive for the Mullen criteria. Multivariate analysis showed that male gender, hepatitis C (HCV), hepatocellular carcinoma, postoperative bilirubin >7 mg/dL and ALT<188 U/L on postoperative day 1 were predictive of death from hepatic failure in the postoperative period. Age >65 years, HCV, reoperation, and renal failure were significant predictors of overall intra-hospital mortality on multivariate analysis. CONCLUSIONS The Mullen criteria were more accurate than the 50/50 criteria in predicting death from hepatic failure in patients undergoing right hepatectomy. A bilirubin peak >7 mg/dL in the postoperative period, HCV positivity, hepatocellular carcinoma, and an ALT level <188 U/L on postoperative day 1 were associated with death from hepatic failure in our patient population.
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Affiliation(s)
- Filippo Filicori
- General Surgery and Transplant Unit, Department of General Surgery and Organ Transplantation, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
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Adam R, De Gramont A, Figueras J, Guthrie A, Kokudo N, Kunstlinger F, Loyer E, Poston G, Rougier P, Rubbia-Brandt L, Sobrero A, Tabernero J, Teh C, Van Cutsem E. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist 2012; 17:1225-39. [PMID: 22962059 DOI: 10.1634/theoncologist.2012-0121] [Citation(s) in RCA: 409] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
An international panel of multidisciplinary experts convened to develop recommendations for the management of patients with liver metastases from colorectal cancer (CRC). The aim was to address the main issues facing the CRC hepatobiliary multidisciplinary team (MDT) when managing such patients and to standardize the treatment patients receive in different centers. Based on current evidence, the group agreed on a number of issues including the following: (a) the primary aim of treatment is achieving a long disease-free survival (DFS) interval following resection; (b) assessment of resectability should be performed with high-quality cross-sectional imaging, staging the liver with magnetic resonance imaging and/or abdominal computed tomography (CT), depending on local expertise, staging extrahepatic disease with thoracic and pelvic CT, and, in selected cases, fluorodeoxyglucose positron emission tomography with ultrasound (preferably contrast-enhanced ultrasound) for intraoperative staging; (c) optimal first-line chemotherapy-doublet or triplet chemotherapy regimens combined with targeted therapy-is advisable in potentially resectable patients; (d) in this situation, at least four courses of first-line chemotherapy should be given, with assessment of tumor response every 2 months; (e) response assessed by the Response Evaluation Criteria in Solid Tumors (conventional chemotherapy) or nonsize-based morphological changes (antiangiogenic agents) is clearly correlated with outcome; no imaging technique is currently able to accurately diagnose complete pathological response but high-quality imaging is crucial for patient management; (f) the duration of chemotherapy should be as short as possible and resection achieved as soon as technically possible in the absence of tumor progression; (g) the number of metastases or patient age should not be an absolute contraindication to surgery combined with chemotherapy; (h) for synchronous metastases, it is not advisable to undertake major hepatic surgery during surgery for removal of the primary CRC; the reverse surgical approach (liver first) produces as good an outcome as the conventional approach in selected cases; (i) for patients with resectable liver metastases from CRC, perioperative chemotherapy may be associated with a modestly better DFS outcome; and (j) whether initially resectable or unresectable, cure or at least a long survival duration is possible after complete resection of the metastases, and MDT treatment is essential for improving clinical and survival outcomes. The group proposed a new system to classify initial unresectability based on technical and oncological contraindications.
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Affiliation(s)
- René Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, UMR-S 776, Villejuf, France.
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Brouquet A, Nordlinger B. Neoadjuvant Chemotherapy Prior to Resection of Colorectal Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2012. [DOI: 10.1007/s11888-012-0135-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tsoulfas G, Pramateftakis MG. Management of rectal cancer and liver metastatic disease: which comes first? Int J Surg Oncol 2012; 2012:196908. [PMID: 22778934 PMCID: PMC3388298 DOI: 10.1155/2012/196908] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 04/28/2012] [Indexed: 02/05/2023] Open
Abstract
In the last few decades there have been significant changes in the approach to rectal cancer management. A multimodality approach and advanced surgical techniques have led to an expansion of the treatment of metastatic disease, with improved survival. Hepatic metastases are present at one point or another in about 50% of patients with colorectal cancer, with surgical resection being the only chance for cure. As the use of multimodality treatment has allowed the tackling of more complicated cases, one of the main questions that remain unanswered is the management of patients with synchronous rectal cancer and hepatic metastatic lesions. The question is one of priority, with all possible options being explored. Specifically, these include the simultaneous rectal cancer and hepatic metastases resection, the rectal cancer followed by chemotherapy and then by the liver resection, and finally the "liver-first" option. This paper will review the three treatment options and attempt to dissect the indications for each. In addition, the role of laparoscopy in the synchronous resection of rectal cancer and hepatic metastases will be reviewed in order to identify future trends.
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Affiliation(s)
- Georgios Tsoulfas
- 1st Surgical Department, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56429 Thessaloniki, Greece
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Viganò L, Russolillo N, Ferrero A, Langella S, Sperti E, Capussotti L. Evolution of long-term outcome of liver resection for colorectal metastases: analysis of actual 5-year survival rates over two decades. Ann Surg Oncol 2012; 19:2035-2044. [PMID: 22219066 DOI: 10.1245/s10434-011-2186-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Liver resection (LR) is the only potentially curative treatment of colorectal liver metastases (CRLM). Its outcome over the past 2 decades was studied using actual 5-year survival rates. METHODS Data of 393 consecutive patients who underwent LR for CRLM at Mauriziano Umberto I (Turin) until June 2005 were analyzed. Excluding R2 resections (n = 4) or incomplete 5-year follow-up (n = 13), 376 patients were divided according to LR date into groups A (before 1995: 90 patients), B (1995-2000: 94 patients), C (2001-2005: 192). RESULTS Group C presented increased multiple and bilobar metastases compared with combined group A and B (C vs AB: 54.7% vs 40.2%, P = 0.005; 28.1% vs 19.0%, P = 0.038, respectively), decreased metastases diameter (C vs AB: 32 vs 40 mm, P = 0.0001). The 5-year overall survival, calculated excluding 4 operative mortalities (group AB), increased over the years (A, 20.5%; B, 32.6%; C, 46.4%; P < 0.0001). Early recurrences (1 year) were not decreased, extrahepatic recurrences even increased (C vs AB: 17.2% vs 8.6%, P = 0.015). Recurrence-free 5-year survival improved (C vs AB: 23.4% vs 13.9%, P = 0.019) linked to decreased liver recurrences (C vs AB: 26.8% vs 37.4%, P = 0.023). Resection rate (59% overall for liver recurrence) increased along with 5-year survival after recurrence (A, 4.0%; B, 14.2%; C, 21.4%; P < 0.0001). Survival improvement was confirmed for multiple (P = 0.003) and synchronous metastases (P = 0.008), N+ tumors (P = 0.005), and in patients without chemotherapy (P = 0.001). CONCLUSIONS Long-term outcome of LR for CRLM improved over 20 years, even in patients with negative prognostic factors, linked to hepatic recurrences reduction and increased survival after recurrence.
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Affiliation(s)
- Luca Viganò
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy.
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