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Whitrock JN, Justiniano CF. Management of Colorectal Cancer With Synchronous Liver Metastases. Dis Colon Rectum 2024; 67:13-16. [PMID: 37878464 DOI: 10.1097/dcr.0000000000003135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Jenna N Whitrock
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
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Zhang H, Wu C, Chen M, Sun Y, Han J. Drug-eluting bead transarterial chemoembolization (DEB-TACE) versus conventional transarterial chemoembolization (cTACE) in colorectal liver metastasis: Efficacy, safety, and prognostic factors. J Cancer Res Ther 2023; 19:1525-1532. [PMID: 38156918 DOI: 10.4103/jcrt.jcrt_2143_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 09/04/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To comparatively evaluate drug-eluting bead transarterial chemoembolization (DEB-TACE) and conventional transarterial chemoembolization (cTACE) for efficacy, safety, and related prognostic factors in the treatment of colorectal liver metastasis (CRLM). MATERIALS AND METHODS This study retrospectively analyzed 75 patients with CRLM-administered DEB-TACE (n = 36) or cTACE (n = 39) between January 2016 and December 2017. Local control, survival outcome, and complications were compared between the two groups. Univariate and multivariate analyses of prognostic factors affecting progression-free survival (PFS) and overall survival (OS) were performed. RESULTS The median follow-up in the two groups was 10.5 months (range, 0.5-22). Median PFS and OS in the DEB-TACE group were 10.0 and 13.0 months, respectively, and 6.0 and 8.5 months in the cTACE group, respectively (P = 0.009 and P = 0.008). The 3-, 6-, and 12-month OS rates in the DEB-TACE group were 100.0%, 94.4%, and 55.6%, respectively, and 92.3%, 71.8%, and 35.9% in the cTACE group, respectively. The 3-month OS rate (P = 0.083) showed no significant difference between the two groups, but significant differences were found in the 6- and 12-month OS rates (P = 0.008 and P = 0.030). Univariate and multivariate survival analyses showed that treatment method, tumor size, and tumor number were independent prognostic factors affecting PFS and OS. CONCLUSION DEB-TACE has advantages over cTACE in prolonging PFS and OS in patients with CRLM. Treatment method, tumor number, and tumor size are important prognostic factors affecting PFS and OS. However, further multicenter and prospective trials are needed to confirm a deeper comparison between DEB-TACE and cTACE in patients with CRLM.
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Affiliation(s)
- Hao Zhang
- Interventional Radiology Department, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Chunxue Wu
- Interventional Radiology Department, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Miaoling Chen
- Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Yuandong Sun
- Interventional Radiology Department, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Jianjun Han
- Interventional Radiology Department, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
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Maes-Carballo M, Gómez-Fandiño Y, García-García M, Martín-Díaz M, De-Dios-de-Santiago D, Khan KS, Bueno-Cavanillas A. Colorectal cancer treatment guidelines and shared decision making quality and reporting assessment: Systematic review. PATIENT EDUCATION AND COUNSELING 2023; 115:107856. [PMID: 37451055 DOI: 10.1016/j.pec.2023.107856] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Physicians must share decisions and choose personalised treatments regarding patients´ beliefs and values. OBJECTIVE To analyse the quality of the recommendations about shared decision making (SDM) in colorectal (CRC) and anal cancer treatment clinical practice guidelines (CPGs) and consensus statements (CSs). METHODS Guidelines were systematically reviewed following prospective registration (Prospero: CRD42021286146) without language restrictions searching 15 databases and 59 professional society websites from January 2010 to November 2021. A validated 31-item SDM quality assessment tool was employed to extract data in duplicate. RESULTS We identified 134 guidelines. Only 46/134 (34.3 %) mentioned SDM. Fifteen (11.1 %) made clear, precise and actionable recommendations, while 9/134 (6.7 %) indicated the strength of the SDM-related recommendations. CPGs underpinned by systematic reviews reported SDM more often than those based on consensus or reviews (35.9 % vs 32.0 %; p = 0.031). Guidelines that reported following quality tools (i.e., AGREE II) more commonly commented about SDM than when it was not reported (75.0 % vs 32.0 %; p = 0.003). CONCLUSION AND PRACTICE IMPLICATIONS Most of the CRC and anal treatment guidelines did not mention SDM and it was superficial. Guidelines based on systematic reviews and those using quality tools demonstrated better reporting of SDM. Recommendations about SDM in these guidelines merit urgent improvement.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain; Hospital Público de Verín, Ourense, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Yolanda Gómez-Fandiño
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | - Manuel García-García
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain; University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Whitrock JN, Hartman SJ, Quillin RC, Shah SA. Liver Transplantation for Colorectal Liver Metastases: Is It Appropriate? Adv Surg 2023; 57:171-185. [PMID: 37536852 DOI: 10.1016/j.yasu.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Colorectal cancer with liver metastases is a condition with significant morbidity and mortality that affects many people around the world. Many treatments exist to target liver metastases, including surgical resection, chemotherapy, nonsurgical liver-directed therapies, and liver transplantation. The field of transplant oncology is emerging as a promising alternative to palliative chemotherapy alone in appropriately selected patients. Though few clinical trials have been completed to evaluate safety of liver transplant for colorectal cancer metastases, there are several ongoing trials to hopefully make transplant a viable option for more patients with limited options.
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Affiliation(s)
- Jenna N Whitrock
- University of Cincinnati College of Medicine, Department of Surgery, Division of Transplantation, 231 Albert Sabin Way, Medical Science Building Room 1555, Cincinnati, OH 45267-0558.
| | - Stephen J Hartman
- University of Cincinnati College of Medicine, Department of Surgery, Division of Transplantation, 231 Albert Sabin Way, Medical Science Building Room 1555, Cincinnati, OH 45267-0558
| | - Ralph C Quillin
- University of Cincinnati College of Medicine, Department of Surgery, Division of Transplantation, 231 Albert Sabin Way, Medical Science Building Room 1555, Cincinnati, OH 45267-0558
| | - Shimul A Shah
- University of Cincinnati College of Medicine, Department of Surgery, Division of Transplantation, 231 Albert Sabin Way, Medical Science Building Room 1555, Cincinnati, OH 45267-0558
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Jiao S, Guan X, Niu H, Ma X, Wang K, Liu E, Zhang W, Wei R, Sun P, Chen Y, Wang X. The tumor characteristics, treatment strategy, and prognosis in colorectal cancer patients with synchronous liver metastasis in China and the USA. Int J Colorectal Dis 2023; 38:140. [PMID: 37219592 DOI: 10.1007/s00384-023-04398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE This study performed an analysis of clinicopathological characteristics, surgical treatment strategy, and survival for CRC patients with LM between China and the USA. METHODS The CRC patients with simultaneous LM were identified from the Surveillance, Epidemiology, and End Results (SEER) registry and the Chinese National Cancer Center (CNCC) database from 2010 to 2017. We assessed 3-year cancer-specific survival (CSS) according to surgical treatment strategy and time period. RESULTS Differences in patient age, gender, primary tumor location, tumor grade, tumor histology, and tumor stage were observed between the USA and China. Compared to the USA, a larger proportion of patients in China underwent both primary site resection (PSR) and hepatic resection (HR) (35.1% vs 15.6%, P < 0.001), and fewer patients underwent only PSR in China (29.1% vs 45.1%, P < 0.001). From 2010 to 2017, the proportion of patient who underwent both PSR and HR has increased from 13.9% to 17.4% in the USA and from 25.4% to 39.4% in China. The 3-year CSS were increasing over time in both the USA and China. The 3-year CSS of patients receiving HR and PSR were significantly higher than those receiving only PSR and patients treated with no surgery in the USA and China. There were no significant differences of 3-year CSS between the USA and China after adjustment (P = 0.237). CONCLUSIONS Despite the distinctions of tumor characteristics and surgical strategy in patients with LM between the USA and China, increased adoption of HR has contributed to the profound improvements of survival during recent decade.
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Affiliation(s)
- Shuai Jiao
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xu Guan
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Haitao Niu
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Xiaolong Ma
- Department of Colorectal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Kaifeng Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Enrui Liu
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Weiyuan Zhang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ran Wei
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Peng Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Yinggang Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
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Modest DP, Karthaus M, Kasper S, Moosmann N, Keitel V, Kiani A, Uhlig J, Jacobasch L, Fischer V Weikersthal L, Fuchs M, Kaiser F, Lerchenmüller C, Sent D, Junghanß C, Held S, Lorenzen S, Kaczirek K, Jung A, Stintzing S, Heinemann V. FOLFOX plus panitumumab or FOLFOX alone as additive therapy following R0/1 resection of RAS wild-type colorectal cancer liver metastases - The PARLIM trial (AIO KRK 0314). Eur J Cancer 2022; 173:297-306. [PMID: 35970102 DOI: 10.1016/j.ejca.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/04/2022] [Accepted: 07/08/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE This trial investigates the addition of panitumumab to chemotherapy with fluorouracil/folinic acid and oxaliplatin (FOLFOX) in a 2:1 randomised, controlled, open-label, phase II trial in RAS wild-type colorectal cancer patients with R0/1-resected liver metastases. EXPERIMENTAL DESIGN The primary endpoint was progression-free survival (PFS) two years after randomisation. The experimental arm (12 weeks of biweekly mFOLFOX6 plus panitumumab followed by 12 weeks of panitumumab alone) was considered active if the two-year PFS rate was ≥65%. Based on historical data, a two-year PFS rate of 50% was estimated in the control arm (12 weeks of biweekly FOLFOX). The trial was performed with a power of 80% and an alpha of 0.05. Secondary endpoints included overall survival (OS) and toxicity. The trial is registered with ClinicalTrials.gov, NCT01384994. RESULTS The full analysis set consists of 70 patients (pts) in the experimental arm and 36 pts in the control arm. The primary endpoint was missed with a two-year PFS of 35.7% with FOLFOX plus panitumumab and 30.6% in the control arm. In comparative analyses, trends towards improved PFS (HR 0.83; 95%CI, 0.52-1.33; P = 0.44) and OS (HR 0.70; 95% CI, 0.34-1.46; P = 0.34) were observed in favour of the panitumumab-based study arm. No new or unexpected safety signals were observed with FOLFOX plus panitumumab following liver resection. CONCLUSION The PARLIM trial failed to demonstrate a two-year PFS rate of 65% after resection of colorectal liver metastases. The positive trends in survival endpoints may support future trials evaluating treatment with anti-EGFR agents after resection of liver metastases.
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Affiliation(s)
- Dominik Paul Modest
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Cancer Immunology, Charitéplatz 1, 10117, Berlin, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - Meinolf Karthaus
- Department of Hematology and Oncology, Munich Hospital Neuperlach, Munich, Germany
| | | | | | - Verena Keitel
- Department of Gastroenterology, University of Düsseldorf, Germany
| | | | | | | | | | - Martin Fuchs
- Department of Gastroenterology, Munich Hospital Bogenhausen, Munich, Germany
| | - Florian Kaiser
- Practice Oncology, Hospital Landshut-Achdorf, Landshut, Germany
| | | | - Dagmar Sent
- Oncological Practice, MVZ Hospital Leverkusen, Leverkusen, Germany
| | | | | | - Sylvie Lorenzen
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany; Department of Internal Medicine III (Haematology/Medical Oncology), Technical University of Munich Hospital Rechts der Isar, Munchen, Bayern, Germany
| | - Klaus Kaczirek
- Department of Surgery, University of Vienna, Vienna, Austria
| | - Andreas Jung
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany; Institute of Pathology, Ludwig Maximillians Universität (LMU), Munich, Germany
| | - Sebastian Stintzing
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Cancer Immunology, Charitéplatz 1, 10117, Berlin, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Volker Heinemann
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany; Department of Medicine III & Comprehensive Cancer Center, Hospital of the University (LMU), München, Germany
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Hedrick TL, Zaydfudim VM. Management of Synchronous Colorectal Cancer Metastases. Surg Oncol Clin N Am 2022; 31:265-278. [DOI: 10.1016/j.soc.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Acciuffi S, Meyer F, Bauschke A, Croner R, Settmacher U, Altendorf-Hofmann A. Solitary colorectal liver metastasis: overview of treatment strategies and role of prognostic factors. J Cancer Res Clin Oncol 2021; 148:657-665. [PMID: 34914005 PMCID: PMC8881245 DOI: 10.1007/s00432-021-03880-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/07/2021] [Indexed: 12/09/2022]
Abstract
The following is an overview of the treatment strategies and the prognostic factors to consider in the therapeutic choice of patients characterized by solitary colorectal liver metastasis. Liver resection is the only potential curative option; nevertheless, only 25% of the patients are considered to be eligible for surgery. To expand the potentially resectable pool of patients, surgeons developed multidisciplinary techniques like portal vein embolization, two-stage hepatectomy or associating liver partition and portal vein ligation for staged hepatectomy. Moreover, mini-invasive surgery is gaining support, since it offers lower post-operative complication rates and shorter hospital stay with no differences in long-term outcomes. In case of unresectable disease, various techniques of local ablation have been developed. Radiofrequency ablation is the most commonly used form of thermal ablation: it is widely used for unresectable patients and is trying to find its role in patients with small resectable metastasis. The identification of prognostic factors is crucial in the choice of the treatment strategy. Previous works that focused on patients with solitary colorectal liver metastasis obtained trustable negative predictive factors such as presence of lymph-node metastasis in the primary tumour, synchronous metastasis, R status, right-sided primary colon tumor, and additional presence of extrahepatic tumour lesion. Even the time factor could turn into a predictor of tumour biology as well as further clinical course, and could be helpful to discern patients with worse prognosis.
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Affiliation(s)
- S Acciuffi
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - F Meyer
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - A Bauschke
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - R Croner
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - U Settmacher
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - A Altendorf-Hofmann
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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The chemopreventive effect of thymol against dimethylhydrazine and/or high fat diet-induced colon cancer in rats: Relevance to NF-κB. Life Sci 2021; 274:119335. [PMID: 33713663 DOI: 10.1016/j.lfs.2021.119335] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/24/2022]
Abstract
AIM Evaluating the possible protective effect of thymol as an approach against 1,2 N,N-dimethylhydrazine and/or high-fat diet (HFD)-induced colon cancer. MAIN METHODS Adult male Wistar rats were divided into 7 groups, namely a normal control group, colon cancer groups received DMH (40 mg/kg i.p., twice weekly), 20% HFD and DMH/HFD, thymol (20 mg/kg/day, p.o.), thymol/DMH and thymol/DMH/HFD (treatment of all groups continued for 16 weeks). KEY FINDINGS Thymol significantly reduced the elevated serum levels of colon related tumor markers carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) as well as the apoptotic marker, caspase-3 compared with the colon cancer group. In addition, it mitigated colonic tissue oxidative stress markers and inflammatory mediators. Moreover, the histopathological study revealed reduction of mucous secretion with elongated nuclei, frequent mitotic figures, focal nuclear stratification, mild interstitial edema, and markedly dilated congested blood vessels, aberrant crypt foci (ACF); adenoma with moderate to severe dysplasia of colon corrected by thymol treatment. SIGNIFICANCE The administration of thymol had a promising preclinical protective efficacy and could be considered as a new strategy for the prophylaxis from colon cancer in clinical practices.
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Wu XA, Shi Y, Du SD. Surgical treatment of colorectal liver metastasis. Shijie Huaren Xiaohua Zazhi 2021; 29:110-115. [DOI: 10.11569/wcjd.v29.i3.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Liver metastasis is the most common form of distant metastasis in colorectal cancer and is a key factor for prognosis in patients with colorectal cancer. Surgery may be the only way to cure colorectal liver metastases. This paper mainly summarizes the latest progress in surgical treatment of colorectal liver metastases, including how to increase resection rate of liver metastases with neoadjuvant therapy or staged hepatectomy, the effect of surgical margin on the prognosis of patients, the timing of surgery in patients with synchronous colorectal liver metastasis, the impact of laparoscopic hepatectomy of liver metastases, the application of liver transplantation in patients with colorectal liver metastases, etc, with an aim to help develop an optimal treatment for patients with colorectal liver metastases through combination of surgical innovations with individualized treatment, thereby improving patients' disease-free survival and overall survival.
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Affiliation(s)
- Xiang-An Wu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Dongcheng District, Beijing 100730, China
| | - Yue Shi
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Dongcheng District, Beijing 100730, China
| | - Shun-Da Du
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Dongcheng District, Beijing 100730, China
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Quantified MRI and 25OH-VitD3 can be used as effective biomarkers for patients with neoadjuvant chemotherapy-induced liver injury in CRCLM? BMC Cancer 2020; 20:767. [PMID: 32799832 PMCID: PMC7429712 DOI: 10.1186/s12885-020-07282-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/09/2020] [Indexed: 12/26/2022] Open
Abstract
Background To evaluate proton-density fat-fraction (PDFF) and intravoxel incoherent motion (IVIM) techniques, and human 25-hydroxyvitamin D3 (25OH-VitD3) levels, as potential biomarkers in patients with colorectal cancer with liver metastasis (CRCLM). Changes were compared with those related to chemotherapy-associated steatohepatitis (CASH) and sinusoidal obstruction syndrome (SOS). Methods 63 patients with pathologically confirmed colorectal adenocarcinoma received 4–6 courses of NC before liver resection and underwent magnetic resonance imaging (MRI) with iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantification and IVIM sequences. Blood samples were analyzed using CTCAE. Pathological changes of liver tissues outside the metastases were assessed as the gold standard, and receiver operating characteristic (ROC) curves were analyzed. Results 16 cases had CASH liver injury, 14 cases had SOS changes, and 4 cases had CASH and SOS, and 7 showed no significant changes. Consistency between biochemical indices and pathological findings was poor (kappa = 0.246, p = 0.005). The areas under the ROC curve (AUCs) of ALT, AST, ALP, GGT, and TBIL were 0.571–0.691. AUCs of D, FF, and 25OH-VitD3 exceeded 0.8; when considering these markers together, sensitivity was 85.29% and specificity was 93.13%. ANOVA showed statistically significant differences among D, FF, and 25OH-VitD3 for different grades of liver injury (F = 4.64–26.5, p = 0.000–0.016). Conclusions D, FF, and 25OH-VitD3 are biomarkers for accurate prediction of NC-induced liver injury in patients with CRCLM, while FF and 25OH-VitD3 might be beneficial to distinguish liver injury grades. Trial registration Current Trials was retrospectively registered as ChiCTR1800015242 at Chinese Clinical Trial Registry on March 16, 2018.
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12
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Wang H, Li X, Peng R, Wang Y, Wang J. Stereotactic ablative radiotherapy for colorectal cancer liver metastasis. Semin Cancer Biol 2020; 71:21-32. [PMID: 32629077 DOI: 10.1016/j.semcancer.2020.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 12/24/2022]
Abstract
Survival improvement of colorectal liver metastasis (CRLM) benefits from systemic therapy and metastasis-directed local therapy. Stereotactic ablative body radiotherapy (SABR), as a new efficient metastasis-directed local therapy with a systematic impact, plays a vital role in CRLM multidisciplinary treatment. SABR leads to a dramatic immunological change in the tumor microenvironment (TME) via differential activation of cytoprotective and cytotoxic pathways in malignant and non-malignant cells, in addition to direct tumor cell death. The synergy of SABR and immunotherapy might increase the abscopal response rate of out-field lesions by targeting different steps of the immune-mediated response, in addition to direct intratumoral cell death. The clinical treatment and efficacy of SABR, its influence on TME, and potential molecular underpinnings of which are the topic of this review.
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Affiliation(s)
- Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
| | - Xuemin Li
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
| | - Ran Peng
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
| | - Yuxia Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China.
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Jeyarajah DR, Doyle MBM, Espat NJ, Hansen PD, Iannitti DA, Kim J, Thambi-Pillai T, Visser BC. Role of yttrium-90 selective internal radiation therapy in the treatment of liver-dominant metastatic colorectal cancer: an evidence-based expert consensus algorithm. J Gastrointest Oncol 2020; 11:443-460. [PMID: 32399284 DOI: 10.21037/jgo.2020.01.09] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Surgical resection of colorectal liver metastases is associated with greater survival compared with non-surgical treatment, and a meaningful possibility of cure. However, the majority of patients are not eligible for resection and may require other non-surgical interventions, such as liver-directed therapies, to be converted to surgical eligibility. Given the number of available therapies, a general framework is needed that outlines the specific roles of chemotherapy, surgery, and locoregional treatments [including selective internal radiation therapy (SIRT) with Y-90 microspheres]. Using a data-driven, modified Delphi process, an expert panel of surgical oncologists, transplant surgeons, and hepatopancreatobiliary (HPB) surgeons convened to create a comprehensive, evidence-based treatment algorithm that includes appropriate treatment options for patients stratified by their eligibility for surgical treatment. The group coined a novel, more inclusive phrase for targeted locoregional tumor treatment (a blanket term for resection, ablation, and other emerging locoregional treatments): local parenchymal tumor destruction therapy. The expert panel proposed new nomenclature for 3 distinct disease categories of liver-dominant metastatic colorectal cancer that is consistent with other tumor types: (I) surgically treatable (resectable); (II) surgically untreatable (borderline resectable); (III) advanced surgically untreatable (unresectable) disease. Patients may present at any point in the algorithm and move between categories depending on their response to therapy. The broad intent of therapy is to transition patients toward individualized treatments where possible, given the survival advantage that resection offers in the context of a comprehensive treatment plan. This article reviews what is known about the role of SIRT with Y-90 as neoadjuvant, definitive, or palliative therapy in these different clinical situations and provides insight into when treatment with SIRT with Y-90 may be appropriate and useful, organized into distinct treatment algorithm steps.
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Affiliation(s)
| | | | - N Joseph Espat
- Department of Surgery, Roger Williams Medical Center, Boston University School of Medicine, Providence, RI, USA
| | - Paul D Hansen
- HPB Surgery, Providence Portland Center, Portland, OR, USA
| | - David A Iannitti
- HPB Surgery, Atrium Health, Carolinas Medical Center, Charlotte, NC, USA
| | - Joseph Kim
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Thavam Thambi-Pillai
- Department of Surgery, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
| | - Brendan C Visser
- Department of Surgery, Stanford University Medical Center, CA, USA
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14
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Bhatt A, Glehen O. Extent of Peritoneal Resection for Peritoneal Metastases: Looking Beyond a Complete Cytoreduction. Ann Surg Oncol 2020; 27:1458-1470. [PMID: 31965374 DOI: 10.1245/s10434-020-08208-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Indexed: 12/17/2022]
Abstract
Completeness of cytoreduction is one of the most important prognostic factors impacting outcomes of cytoreductive surgery (CRS). To what extent the surrounding normal peritoneum needs to be removed is not known. We hypothesized that the extent of peritoneal resection should be different for different tumors and performed this study to find evidence to support this rationale. To determine the extent of resection of surrounding tissue for any tumor, the mechanisms of tumor development and spread, tumor morphology, the possibility of finding disease in the surrounding normal tissue, and the pattern of lymph node metastases should be known. Surgical resections also depend on patterns of recurrence and the impact of varying extent of resection on survival. We performed a review of literature pertaining to pathways and patterns of peritoneal cancer spread to determine the scientific basis for the extent of peritonectomy. We also reviewed studies comparing less and more extensive peritoneal resection. There is no consensus on the extent of lymphadenectomy required for most PM. Based on this review, we provide recommendations for the extent of peritoneal resection and the extent of lymph node dissection that should be performed for some common peritoneal tumors and identify areas that require further research. We propose that a systematic method of synoptic reporting of pathological specimens of CRS should be developed to capture information regarding the disease distribution within the peritoneal cavity and morphology of PM from different tumors. This can in future be used to establish standard guidelines for such resections.
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Affiliation(s)
- Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India
| | - Olivier Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Lyon, France.
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15
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Scherman P, Syk I, Holmberg E, Naredi P, Rizell M. Influence of primary tumour and patient factors on survival in patients undergoing curative resection and treatment for liver metastases from colorectal cancer. BJS Open 2019; 4:118-132. [PMID: 32011815 PMCID: PMC6996641 DOI: 10.1002/bjs5.50237] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/16/2019] [Indexed: 12/24/2022] Open
Abstract
Background Resection of the primary tumour is a prerequisite for cure in patients with colorectal cancer, but hepatic metastasectomy has been used increasingly with curative intent. This national registry study examined prognostic factors for radically treated primary tumours, including the subgroup of patients undergoing liver metastasectomy. Methods Patients who had radical resection of primary colorectal cancer in 2009–2013 were identified in a population‐based Swedish colorectal registry and cross‐checked in a registry of liver tumours. Data on primary tumour and patient characteristics were extracted and prognostic impact was analysed. Results Radical resection was registered in 20 853 patients; in 38·7 per cent of those registered with liver metastases, surgery or ablation was performed. The age‐standardized relative 5‐year survival rate after radical resection of colorectal cancer was 80·9 (95 per cent c.i. 80·2 to 81·6) per cent, and the rate after surgery for colorectal liver metastases was 49·6 (46·0 to 53·2) per cent. Multivariable analysis identified lymph node status, multiple sites of metastasis, high ASA grade and postoperative complications after resection of the primary tumour as strong risk factors after primary resection and following subsequent liver resection or ablation. Age, sex and primary tumour location had no prognostic impact on mortality after liver resection. Conclusion Lymph node status and complications have a negative impact on outcome after both primary resection and liver surgery. Older age and female sex were underrepresented in the liver surgical cohort, but these factors did not influence prognosis significantly.
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Affiliation(s)
- P Scherman
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - I Syk
- Department of Surgery, Clinical Sciences in Malmö, Lund University, Malmö, Sweden.,Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - E Holmberg
- Department of Oncology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - P Naredi
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Rizell
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden
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16
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Kron P, Linecker M, Jones RP, Toogood GJ, Clavien PA, Lodge JPA. Ablation or Resection for Colorectal Liver Metastases? A Systematic Review of the Literature. Front Oncol 2019; 9:1052. [PMID: 31750233 PMCID: PMC6843026 DOI: 10.3389/fonc.2019.01052] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Successful use of ablation for small hepatocellular carcinomas (HCC) has led to interest in the role of ablation for colorectal liver metastases (CRLM). However, there remains a lack of clarity about the use of ablation for colorectal liver metastases (CRLM), specifically its efficacy compared with hepatic resection. Methods: A systematic review of the literature on ablation or resection of colorectal liver metastases was performed using MEDLINE, Cochrane Library, and Embase until December 2018. The aim of this study was to summarize the evidence for ablation vs. resection in the treatment of CRLM. Results: This review identified 1,773 studies of which 18 were eligible for inclusion. In the majority of the studies, overall survival (OS) and disease-free survival (DFS) were significantly higher and local recurrence (LR) rates were significantly lower in the resection groups. On subgroup analysis of solitary CRLM, resection was associated with improved OS, DFS, and reduced LR. Three series assessed the outcome of resection vs. ablation for technically resectable CRLM, and showed improved outcome in the resection group. In fact, there were no studies showing a survival advantage of ablation compared to resection in the treatment of CRLM. Conclusions: Resection remains the "gold standard" in the treatment of CRLM and should not be replaced by ablation at present. This review supports the use of ablation only as an adjunct to resection and as a single treatment option when resection is not safely possible.
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Affiliation(s)
- Philipp Kron
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
| | - Michael Linecker
- Department of Surgery and Transplantation, Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland
| | - Robert P Jones
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
| | - Giles J Toogood
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland
| | - J P A Lodge
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
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17
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Meier M, Knudsen AR, Andersen KJ, Ludvigsen M, Eriksen PL, Pedersen AKN, Honoré B, Mortensen FV. Perturbations of urea cycle enzymes during posthepatectomy rat liver failure. Am J Physiol Gastrointest Liver Physiol 2019; 317:G429-G440. [PMID: 31373508 DOI: 10.1152/ajpgi.00293.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Posthepatectomy liver failure (PHLF) may occur after extended partial hepatectomy (PH). If malignancy is widespread in the liver, the size of PH and hence the size of the future liver remnant (FLR) may limit curability. We aimed to characterize differences in protein expression between different sizes of FLRs and identify proteins specific to the regenerative process of minimal-size FLR (MSFLR), with special focus on postoperative day (POD) 1 when PHLF is present. A total of 104 male Wistar rats were subjected to 30, 70, or 90% PH (MSFLR in rats), sham operation, or no operation. Blood and liver tissue were harvested at POD1, 3, and 5 (n = 8 per group). Protein expression was assessed by proteomic profiling by unsupervised two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) liquid chromatography tandem mass spectrometry (LC-MS/MS), followed by supervised selected reaction monitoring (SRM)-MS/MS. In all, 1,035 protein spots were detected, 54 of which were significantly differentially expressed between groups and identifiable. During PHLF after PH(90%) at POD1, urea cycle and related proteins showed significant perturbations, including the urea cycle flux-regulating enzyme of carbamoyl phosphate synthase-1, ornithine transcarbamylase, and arginase-1, as well as the ornithine aminotransferase and propionyl-CoA carboxylase alpha chain. Plasma-ammonia increased significantly at POD1 after PH(90%), followed by a prompt decrease. At the protein level, we found perturbations of urea cycle and related enzymes in the MSFLR during PHLF. Our results suggest that these perturbations may augment urea cycle function, which may be pivotal for increased ammonia elimination after extensive PHs and potential PHLF.NEW & NOTEWORTHY Posthepatectomy liver failure (PHLF) is associated with high mortality. In a rat model of 90% hepatectomy, PHLF is present. Our results on liver tissue proteomics suggest that the ability of the liver remnant to sufficiently eliminate ammonia may be brought about by perturbation related to urea cycle proteins and that enhancing the urea cycle capacity may play a key role in surviving PHLF.
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Affiliation(s)
- Michelle Meier
- Department of Surgery, Section for Upper Gastrointestinal and Hepatico-Pancreatico-Biliary Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Riegels Knudsen
- Department of Surgery, Section for Upper Gastrointestinal and Hepatico-Pancreatico-Biliary Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Jarlhelt Andersen
- Department of Surgery, Section for Upper Gastrointestinal and Hepatico-Pancreatico-Biliary Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Maja Ludvigsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Peter Lykke Eriksen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bent Honoré
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Frank Viborg Mortensen
- Department of Surgery, Section for Upper Gastrointestinal and Hepatico-Pancreatico-Biliary Surgery, Aarhus University Hospital, Aarhus, Denmark
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18
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Hepatic Resection Following Selective Internal Radiation Therapy for Colorectal Cancer Metastases in the FOXFIRE Clinical Trial: Clinical Outcomes and Distribution of Microspheres. Cancers (Basel) 2019; 11:cancers11081155. [PMID: 31408970 PMCID: PMC6721483 DOI: 10.3390/cancers11081155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 12/18/2022] Open
Abstract
The FOXFIRE (5-Fluorouracil, OXaliplatin and Folinic acid ± Interventional Radio-Embolisation) clinical trial combined systemic chemotherapy (OxMdG: Oxaliplatin, 5-fluorouracil and folic acid) with Selective Internal Radiation Therapy (SIRT or radio-embolisation) using yttrium-90 resin microspheres in the first-line management for liver-dominant metastatic colorectal cancer (CRC). We report clinical outcomes for patients having hepatic resection after this novel combination therapy and an exploratory analysis of histopathology. Multi-Disciplinary Teams deemed all patients inoperable before trial registration and reassessed them during protocol therapy. Proportions were compared using Chi-squared tests and survival using Cox models. FOXFIRE randomised 182 participants to chemotherapy alone and 182 to chemotherapy with SIRT. There was no statistically significant difference in the resection rate between groups: Chemotherapy alone was 18%, (n = 33); SIRT combination was 21% (n = 38) (p = 0.508). There was no statistically significant difference between groups in the rate of liver surgery, nor in survival from time of resection (hazard ratio (HR) = 1.55; 95% confidence interval (CI) = 0.83-2.89). In the subgroup studied for histopathology, microsphere density was highest at the tumour periphery. Patients treated with SIRT plus chemotherapy displayed lower values of viable tumour in comparison to those treated with chemotherapy alone (p < 0.05). This study promotes the feasibility of hepatic resection following SIRT. Resin microspheres appear to preferentially distribute at the tumour periphery and may enhance tumour regression.
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19
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Stroud RE, Piccini D, Schoepf UJ, Heerfordt J, Yerly J, Di Sopra L, Rollins JD, Fischer AM, Suranyi P, Varga-Szemes A. Correcting versus resolving respiratory motion in free-breathing whole-heart MRA: a comparison in patients with thoracic aortic disease. Eur Radiol Exp 2019; 3:29. [PMID: 31363865 PMCID: PMC6667582 DOI: 10.1186/s41747-019-0107-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/02/2019] [Indexed: 11/28/2022] Open
Abstract
Background Whole-heart magnetic resonance angiography (MRA) requires sophisticated methods accounting for respiratory motion. Our purpose was to evaluate the image quality of compressed sensing-based respiratory motion-resolved three-dimensional (3D) whole-heart MRA compared with self-navigated motion-corrected whole-heart MRA in patients with known thoracic aorta dilation. Methods Twenty-five patients were prospectively enrolled in this ethically approved study. Whole-heart 1.5-T MRA was acquired using a prototype 3D radial steady-state free-precession free-breathing sequence. The same data were reconstructed with a one-dimensional motion-correction algorithm (1D-MCA) and an extradimensional golden-angle radial sparse parallel reconstruction (XD-GRASP). Subjective image quality was scored and objective image quality was quantified (signal intensity ratio, SIR; vessel sharpness). Wilcoxon, McNemar, and paired t tests were used. Results Subjective image quality was significantly higher using XD-GRASP compared to 1D-MCA (median 4.5, interquartile range 4.5–5.0 versus 4.0 [2.25–4.75]; p < 0.001), as well as signal homogeneity (3.0 [3.0–3.0] versus 2.0 [2.0–3.0]; p = 0.003), and image sharpness (3.0 [2.0–3.0] vs 2.0 [1.25–3.0]; p < 0.001). SIR with the 1D-MCA and XD-GRASP was 6.1 ± 3.9 versus 7.4 ± 2.5, respectively (p < 0.001); while signal homogeneity was 274.2 ± 265.0 versus 199.8 ± 67.2 (p = 0.129). XD-GRASP provided a higher vessel sharpness (45.3 ± 10.7 versus 40.6 ± 101, p = 0.025). Conclusions XD-GRASP-based motion-resolved reconstruction of free-breathing 3D whole-heart MRA datasets provides improved image contrast, sharpness, and signal homogeneity and seems to be a promising technique that overcomes some of the limitations of motion correction or respiratory navigator gating.
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Affiliation(s)
- Robert E Stroud
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Davide Piccini
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 7.84, 1010, Lausanne, Switzerland.,Advanced Clinical Imaging Technology, Siemens Healthcare AG, EPFL QI-E, 1015, Lausanne, Switzerland
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - John Heerfordt
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 7.84, 1010, Lausanne, Switzerland.,Advanced Clinical Imaging Technology, Siemens Healthcare AG, EPFL QI-E, 1015, Lausanne, Switzerland
| | - Jérôme Yerly
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 7.84, 1010, Lausanne, Switzerland.,Center for Biomedical Imaging (CIBM), Rue de Bugnon 46, BH 7.84, 1010, Lausanne, Switzerland
| | - Lorenzo Di Sopra
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 7.84, 1010, Lausanne, Switzerland
| | - Jonathan D Rollins
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Andreas M Fischer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA.,Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA.
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20
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Analysis on Effects of Comprehensive Nursing Care Applied in Interventional Therapy for Patients with Liver Cirrhosis and Liver Cancer. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:494-500. [PMID: 31223577 PMCID: PMC6570817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study aimed to investigate the effects of comprehensive nursing intervention in interventional therapy for patients with liver cirrhosis and liver cancer. METHODS Overall, 512 liver cirrhosis patients complicated with liver cancer receiving interventional therapy in the Department of Oncology of the Second Hospital of Dalian Medical University (Dalian, China) from March 2010 to March 2016 were retrospectively analyzed. Patients were divided into observation group (n=310) and control group (n=202). Comprehensive nursing intervention was applied to observation group and conventional nursing care was applied to control group. RESULTS The degrees of satisfaction before and after nursing intervention, quality-of-life scores, incidences of postoperative complications and survival rates at 20 months after operation of the two groups were compared. The degree of great satisfaction in observation group was significantly higher than that in control group (P<0.001). The quality-of-life scores of the patients in observation group were obviously higher than those in control group (P<0.001). The incidence of postoperative complications in observation group was significantly lower than that in control group (P<0.001). The survival rates in observation group was significantly higher than that in control group (P=0.035). CONCLUSION The application of comprehensive nursing intervention in the interventional therapy for liver cirrhosis and liver cancer can notably improve the life quality of the patients, lower the incidence of postoperative complications and increase the survival rate, which is worthy of clinical popularization and application.
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21
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Levy J, Zuckerman J, Garfinkle R, Acuna SA, Touchette J, Vanounou T, Pelletier JS. Intra-arterial therapies for unresectable and chemorefractory colorectal cancer liver metastases: a systematic review and meta-analysis. HPB (Oxford) 2018; 20:905-915. [PMID: 29887263 DOI: 10.1016/j.hpb.2018.04.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/17/2018] [Accepted: 04/21/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND A large proportion of patients with colorectal cancer liver metastases (CRCLM) not amenable to curative liver resection will progress on systemic therapy. Intra-arterial therapies (IAT) including conventional transarterial chemoembolization (cTACE), drug eluting beads (DEB-TACE) and yttrium-90 radioembolization (Y-90) are indicated to prolong survival and palliate symptoms. The purpose of this systematic review and meta-analysis is to compare the survival benefit and radiologic response of three intra-arterial therapies in patients with chemorefractory and unresectable CRCLM. METHODS A systematic search for eligible references in the Cochrane Library and the EMBASE, MEDLINE and TRIP databases from January 2000 to November 2016 was performed in accordance with PRISMA guidelines. Methodological quality of included studies was assessed using the MINORS scale. One-year overall survival rates and RECIST responder rates were pooled using inverse-variance weighted random-effects models. Overall survival outcomes were collected according to transformed pooled median survivals from first IAT with a subgroup analysis of patients with extrahepatic disease. RESULTS Twenty-three prospective studies were included and analyzed: 5 cTACE (n = 746), 5 DEB-TACE (n = 222) and 13 Y-90 (n = 615). All but five were clinical trials. Eleven of 13 Y-90 studies were industry funded. Pooled RECIST response rates with 95% confidence intervals (CI) were: cTACE 23% (9.7, 36), DEB-TACE 36% (0, 73) and Y-90 23% (11, 34). The pooled 1-year survival rates with CI were: cTACE, 70% (49, 87), DEB-TACE, 80% (74, 86) and Y-90, 41% (28, 54). Transformed pooled median survivals from first IAT and ranges for cTACE, DEB-TACE and Y-90 were 16 months (9.0-23), 16 months (7.3-25) and 12 months (7.0-15), respectively. Significant heterogeneity in inclusion criteria and reporting of confounders, including previous therapy, tumor burden and post-IAT therapy, precluded statistical comparisons between the three therapies. CONCLUSION Methodological and statistical heterogeneity precluded consensus on the optimal treatment strategy. Given the common use and significant cost of radioembolization in this setting, a more robust prospective comparative trial is warranted.
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Affiliation(s)
- Jordan Levy
- University of Toronto Division of General Surgery, Toronto, ON, Canada; University of Toronto Institute of Health Policy Management and Evaluation, Toronto, ON, Canada.
| | - Jesse Zuckerman
- University of Toronto Division of General Surgery, Toronto, ON, Canada
| | - Richard Garfinkle
- Sir Mortimer B Davis Jewish General Hospital, Hepatobiliary and Pancreatic Surgery, Montreal, QC, Canada
| | - Sergio A Acuna
- University of Toronto Division of General Surgery, Toronto, ON, Canada; University of Toronto Institute of Health Policy Management and Evaluation, Toronto, ON, Canada
| | - Jacynthe Touchette
- Sir Mortimer B Davis Jewish General Hospital Health Sciences Library, Montreal, QC, Canada
| | - Tsafrir Vanounou
- Sir Mortimer B Davis Jewish General Hospital, Hepatobiliary and Pancreatic Surgery, Montreal, QC, Canada
| | - Jean-Sebastien Pelletier
- Sir Mortimer B Davis Jewish General Hospital, Hepatobiliary and Pancreatic Surgery, Montreal, QC, Canada
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QUIREZE JUNIOR C, BRASIL AMS, MORAIS LK, CAMPION ERL, TAVEIRA EJF, RASSI MC. METACHRONOUS COLORECTAL LIVER METASTASES HAS BETTER PROGNOSIS - IS IT TRUE? ARQUIVOS DE GASTROENTEROLOGIA 2018; 55:258-263. [DOI: 10.1590/s0004-2803.201800000-64] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/05/2018] [Indexed: 12/24/2022]
Abstract
ABSTRACT BACKGROUND: Liver metastases from colorectal cancer are an important public health problem due to the increasing incidence of colorectal cancer worldwide. Synchronous colorectal liver metastasis has been associated with worse survival, but this prognosis is controversial. OBJECTIVE: The objective of this study was to evaluate the recurrence-free survival and overall survival between groups of patients with metachronous and synchronous colorectal hepatic metastasis. METHODS: This was a retrospective analysis of medical records of patients with colorectal liver metastases seen from 2013 to 2016, divided into a metachronous and a synchronous group. The Cox regression model and the Kaplan-Meier method with log-rank test were used to compare survival between groups. RESULTS: The mean recurrence-free survival was 9.75 months and 50% at 1 year in the metachronous group and 19.73 months and 63.3% at 1 year in the synchronous group. The mean overall survival was 20.00 months and 6.2% at 3 years in the metachronous group and 30.39 months and 31.6% at 3 years in the synchronous group. Patients with metachronous hepatic metastasis presented worse overall survival in multivariate analysis. The use of biological drugs combined with chemotherapy was related to the best overall survival prognosis. CONCLUSION: Metachronous colorectal hepatic metastasis was associated with a worse prognosis for overall survival. There was no difference in recurrence-free survival between metachronous and synchronous metastases.
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Sutton P, Vimalachandran D, Poston G, Fenwick S, Malik H. Oncosurgical Management of Liver Limited Stage IV Colorectal Cancer: Preliminary Data and Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e125. [PMID: 29743154 PMCID: PMC5966652 DOI: 10.2196/resprot.9453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/20/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022] Open
Abstract
Background Colorectal cancer is the fourth commonest cancer and second commonest cause of cancer-related death in the United Kingdom. Almost 15% of patients have metastases on presentation. An increasing number of surgical strategies and better neoadjuvant treatment options are responsible for more patients undergoing resection of liver metastases, with prolonged survival in a select group of patients who present with synchronous disease. It is clear that the optimal strategy for the management of these patients remains unclear, and there is certainly a complete absence of Level 1 evidence in the literature. Objective The objective of this study is to undertake preliminary work and devise an outline trial protocol to inform the future development of clinical studies to investigate the management of patients with liver limited stage IV colorectal cancer. Methods We have undertaken some preliminary work and begun the process of designing a randomized controlled trial and present a draft trial protocol here. Results This study is at the protocol development stage only, and as such no results are available. There is no funding in place for this study, and no anticipated start date. Conclusions We have presented preliminary work and an outline trial protocol which we anticipate will inform the future development of clinical studies to investigate the management of patients with liver limited stage IV colorectal cancer. We do not believe that the trial we have designed will answer the most significant clinical questions, nor that it is feasible to be delivered within the United Kingdom’s National Health Service at this current time.
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Affiliation(s)
- Paul Sutton
- Aintree University Hospital, Liverpool, United Kingdom
- Countess of Chester Hospital, Chester, United Kingdom
| | | | - Graeme Poston
- Aintree University Hospital, Liverpool, United Kingdom
| | | | - Hassan Malik
- Aintree University Hospital, Liverpool, United Kingdom
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Xue L, Williamson A, Gaines S, Andolfi C, Paul-Olson T, Neerukonda A, Steinhagen E, Smith R, Cannon LM, Polite B, Umanskiy K, Hyman N. An Update on Colorectal Cancer. Curr Probl Surg 2018; 55:76-116. [PMID: 29631699 DOI: 10.1067/j.cpsurg.2018.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lai Xue
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | | | - Sara Gaines
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Ciro Andolfi
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Terrah Paul-Olson
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Anu Neerukonda
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Emily Steinhagen
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Radhika Smith
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Lisa M Cannon
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Blasé Polite
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | | | - Neil Hyman
- Department of Surgery, University of Chicago Medicine, Chicago, IL.
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25
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Sellier F, Bories E, Sibertin-Blanc C, Griffiths K, Dahan L, Giovannini M, Gaudart J, Seitz JF, Laugier R, Caillol F, Grandval P. Clinical outcome after biliary drainage for metastatic colorectal cancer: Survival analysis and prognostic factors. Dig Liver Dis 2018; 50:189-194. [PMID: 29054396 DOI: 10.1016/j.dld.2017.09.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/08/2017] [Accepted: 09/10/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Biliary obstruction secondary to colorectal cancer liver metastases is associated with a poor prognosis especially when chemotherapy cannot be re-started. The aim of this study was to determine the survival after biliary drainage and the associated prognostic factors. METHODS Patients from two French centers were included retrospectively after first biliary endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography drainage for biliary obstruction secondary to liver metastases of colorectal cancer, occurring during chemotherapy. RESULTS The final analysis included 69 patients. Overall median survival was 115 days. In univariate analysis, a previous liver surgery, technical and functional success of drainage and restarted chemotherapy were significantly associated with an improved survival. Chemotherapy was restarted after a median of 27 days. When drainage was efficient, survival improved from 33 to 262days (p<0.001). In multivariate analysis, significant protective factors for survival included previous a hepatectomy (HR 0.41) and functional success of the drainage (HR 0.29). Predictive factors for death included increased lines of chemotherapy (HR 1.68) and fever before drainage (HR 2.97). CONCLUSIONS This is the first study concerning the benefits of biliary drainage for malignant biliary obstruction during the course of chemotherapy for colorectal cancer. A successful biliary drainage leads to improved survival and allows achievement of chemotherapy for 70% of patients.
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Affiliation(s)
| | - Erwan Bories
- Endoscopy and Gastroenterology Departement, Paoli-Calmettes Institute, Marseille, France
| | | | - Karolina Griffiths
- Department of Public Health and Medical Information, Timone Hospital, Marseille, France
| | - Laetitia Dahan
- Digestive Oncology Department, Timone Hospital, Marseille, France
| | - Marc Giovannini
- Endoscopy and Gastroenterology Departement, Paoli-Calmettes Institute, Marseille, France
| | - Jean Gaudart
- Department of Public Health and Medical Information, Timone Hospital, Marseille, France; Aix-Marseille Université, UMR_S 912 (SESSTIM), IRD, Marseille, France; Digestive Oncology Department, Timone Hospital, Marseille, France
| | | | - Rene Laugier
- Gastroenterology Department, Timone Hospital, Marseille, France
| | - Fabrice Caillol
- Endoscopy and Gastroenterology Departement, Paoli-Calmettes Institute, Marseille, France
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The New Era of Transplant Oncology: Liver Transplantation for Nonresectable Colorectal Cancer Liver Metastases. Can J Gastroenterol Hepatol 2018; 2018:9531925. [PMID: 29623268 PMCID: PMC5829429 DOI: 10.1155/2018/9531925] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/31/2017] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the third most incident cancer worldwide. Most of CRC patients will develop distant metastases, mainly to the liver, and liver resection is the only potential chance for cure. On the other hand, only a small proportion of patients with hepatic CRC metastasis are candidates for upfront liver resection. Liver transplantation (LT) is an attractive option for patients with nonresectable CRC liver metastases (NRCLM) without extrahepatic involvement. Initial experiences with LT for NRCLM achieved very poor outcomes, with a 5-year overall survival (OS) lower than 20%. However, these initial studies did not have a standardized patient selection or neoadjuvant or adjuvant therapies. With recent advances in the surgical and medical oncology fields, the landscape has changed. Recent studies from Norway have shown an encouraging 5-year OS of 50% when transplanting patients with NRCLM. Nevertheless, the main concern when expanding the indications for LT is organ shortage. To manage this organ shortage, strategies utilizing live donor liver transplantation are gaining favor. A few ongoing trials are assessing the impact of LT in NRCLM patient survival. Therefore, the aim of this paper is to review the current status of LT for NRCLM.
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27
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Modest D, Denecke T, Pratschke J, Ricard I, Lang H, Bemelmans M, Becker T, Rentsch M, Seehofer D, Bruns C, Gebauer B, Modest H, Held S, Folprecht G, Heinemann V, Neumann U. Surgical treatment options following chemotherapy plus cetuximab or bevacizumab in metastatic colorectal cancer—central evaluation of FIRE-3. Eur J Cancer 2018; 88:77-86. [DOI: 10.1016/j.ejca.2017.10.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 10/23/2017] [Indexed: 01/09/2023]
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Meier M, Knudsen AR, Andersen KJ, Bjerregaard NC, Jensen UB, Mortensen FV. Gene Expression in the Liver Remnant Is Significantly Affected by the Size of Partial Hepatectomy: An Experimental Rat Study. Gene Expr 2017; 17:289-299. [PMID: 28488569 PMCID: PMC5885150 DOI: 10.3727/105221617x695825] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Extended hepatectomies may result in posthepatectomy liver failure, a condition with a high mortality. The main purpose of the present study was to investigate and compare the gene expression profiles in rats subjected to increasing size of partial hepatectomy (PH). Thirty Wistar rats were subjected to 30%, 70%, or 90% PH, sham operation, or no operation. Twenty-four hours following resection, liver tissue was harvested and genome-wide expression analysis was performed. Cluster analysis revealed two main groupings, one containing the PH(90%) and one containing the remaining groups [baseline, sham, PH(30%), and PH(70%)]. Categorization of specific affected molecular pathways in the PH(90%) group revealed a downregulation of cellular homeostatic function degradation and biosynthesis, whereas proliferation, cell growth, and cellular stress and injury were upregulated in the PH(90%) group. After PH(90%), the main upregulated pathways were mTOR and ILK. The main activated upstream regulators were hepatocyte growth factor and transforming growth factor. With decreasing size of the future liver remnant, the liver tended to prioritize expression of genes involved in cell proliferation and differentiation at the expense of genes involved in metabolism and body homeostasis. This prioritizing may be an essential molecular explanation for posthepatectomy liver failure.
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Affiliation(s)
- Michelle Meier
- *Department of Surgical Gastroenterology, Section for Upper Gastrointestinal and Hepato-Pancretico-Biliary Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Riegels Knudsen
- *Department of Surgical Gastroenterology, Section for Upper Gastrointestinal and Hepato-Pancretico-Biliary Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Jarlhelt Andersen
- *Department of Surgical Gastroenterology, Section for Upper Gastrointestinal and Hepato-Pancretico-Biliary Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Christian Bjerregaard
- *Department of Surgical Gastroenterology, Section for Upper Gastrointestinal and Hepato-Pancretico-Biliary Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Uffe Birk Jensen
- †Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
- ‡Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Frank Viborg Mortensen
- *Department of Surgical Gastroenterology, Section for Upper Gastrointestinal and Hepato-Pancretico-Biliary Surgery, Aarhus University Hospital, Aarhus, Denmark
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Correlation analysis between liver metastasis and serum levels of miR‑200 and miR‑141 in patients with colorectal cancer. Mol Med Rep 2017; 16:7791-7795. [PMID: 28944840 DOI: 10.3892/mmr.2017.7538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/06/2017] [Indexed: 01/01/2023] Open
Abstract
Colorectal cancer has become a disease with one of the highest incidence rates worldwide, and liver metastasis threatens the prognosis of colorectal cancer. MicroRNA (miR)‑200 and miR‑141 have been confirmed to be aberrantly expressed in colorectal cancer, however, whether miR‑200 and miR‑141 are involved in the progression of colorectal cancer, and their role in liver metastasis remain to be fully elucidated. The aim of the present study was to investigate the role of miR‑200 and miR‑141 in the progression and liver metastasis of colorectal cancer in patients. A total of 380 patients with colorectal cancer were enrolled, of which 142 were diagnosed with grade I/II disease and 238 were grade III/IV disease. Reverse transcription‑quantitative polymerase chain reaction analysis was performed to examine the serum levels of miR‑200 and miR‑141. In addition, transfection was performed in HCT116 and SW480 cells to establish overexpression models for miR‑200 and miR‑141. A TUNEL assay was performed to assess apoptosis and a Transwell experiment was performed to examine cell migration. Compared with the control group, the serum levels of miR‑200 and miR‑141 were significantly increased in the colorectal cancer group (P<0.05). Compared with the patients with colorectal cancer without liver metastasis, patients with liver metastasis had significantly higher serum levels of miR‑200 and miR‑141 (P<0.05). The overexpression of miR‑200 and miR‑141 inhibited apoptosis of the HC116 and SW480 cells, and enhanced cell migration. The upregulation of serum miR‑200 and miR‑141 were associated with liver metastasis in patients with colorectal cancer. Taken together, the overexpression of miR‑200 and miR‑141 exacerbated liver metastasis of colorectal cancer via inhibiting apoptosis and inducing migration.
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30
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Coronary artery assessment using self-navigated free-breathing radial whole-heart magnetic resonance angiography in patients with congenital heart disease. Eur Radiol 2017; 28:1267-1275. [DOI: 10.1007/s00330-017-5035-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
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31
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Weledji EP. Centralization of Liver Cancer Surgery and Impact on Multidisciplinary Teams Working on Stage IV Colorectal Cancer. Oncol Rev 2017; 11:331. [PMID: 28814999 PMCID: PMC5538223 DOI: 10.4081/oncol.2017.331] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/15/2016] [Accepted: 07/17/2017] [Indexed: 12/17/2022] Open
Abstract
Surgical resection is the most effective treatment approach for colorectal liver metastases but only a minority of patients is suitable for upfront surgery. The treatment strategies of stage IV colorectal cancer have shifted towards a continuum of care in which medical and surgical treatment combinations are tailored to the clinical setting of the individual patient. The optimization of treatment through appropriate decision-making and multimodal therapy for stage IV colorectal cancer require a joint multidisciplinary meeting in a centralized liver cancer unit.
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32
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Fiorentini G, Sarti D, Aliberti C, Carandina R, Mambrini A, Guadagni S. Multidisciplinary approach of colorectal cancer liver metastases. World J Clin Oncol 2017; 8:190-202. [PMID: 28638789 PMCID: PMC5465009 DOI: 10.5306/wjco.v8.i3.190] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/05/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
Large bowel cancer is a worldwide public health challenge. More than one third of patients present an advanced stage of disease at diagnosis and the liver is the most common site of metastases. Selection criteria for early diagnosis, chemotherapy and surgery have been recently expanded. The definition of resectability remains unclear. The presence of metastases is the most significant prognostic factor. For this reason the surgical resection of hepatic metastases is the leading treatment. The most appropriate resection approach remains to be defined. The two step and simultaneous resection processes of both primary and metastases have comparable survival long-term outcomes. The advent of targeted biological chemotherapeutic agents and the development of loco-regional therapies (chemoembolization, thermal ablation, arterial infusion chemotherapy) contribute to extend favorable results. Standardized evidence-based protocols are missing, hence optimal management of hepatic metastases should be single patient tailored and decided by a multidisciplinary team. This article reviews the outcomes of resection, systemic and loco-regional therapies of liver metastases originating from large bowel cancer.
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33
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Al Bandar MH, Kim NK. Current status and future perspectives on treatment of liver metastasis in colorectal cancer (Review). Oncol Rep 2017; 37:2553-2564. [PMID: 28350137 DOI: 10.3892/or.2017.5531] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 03/13/2017] [Indexed: 12/29/2022] Open
Abstract
Liver metastasis is the most common site of colorectal cancer (CRC) metastasis. Approximately half of all colorectal cancer patients will develop liver metastases. Although radical surgery is the standard treatment modality, only 10-20% of patients are deemed eligible for resection. Despite advances in survival with chemotherapy, surgical resection is still considered the only curative option for patients with liver metastases. Much effort has been expended to address patients with metastatic liver disease. The majority of evidence stated a significant survival benefit with surgical resection to reach an overall 5-year survival rate of 35-55% after hepatic resection. However, still majority of patients will experience disease recurrence even after a successful resection. In this review, we describe current status and controversies related to treatment options for CRC liver metastases and its potential for enhancing oncologic outcomes and improving quality of life.
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Affiliation(s)
- Mahdi Hussain Al Bandar
- Department of Surgery, Yonsei University, College of Medicine, Seoul 120-752, Republic of Korea
| | - Nam Kyu Kim
- Department of Surgery, Yonsei University, College of Medicine, Seoul 120-752, Republic of Korea
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34
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Ribeiro HSDC, Torres OJM, Marques MC, Herman P, Kalil AN, Fernandes EDSM, Oliveira FFD, Castro LDS, Hanriot R, Oliveira SCR, Boff MF, Costa WLD, Gil RDA, Pfiffer TEF, Makdissi FF, Rocha MDS, Amaral PCGD, Costa LAGDA, Aloia TA. I BRAZILIAN CONSENSUS ON MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 2: APPROACH TO RESECTABLE METASTASES. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:9-13. [PMID: 27120731 PMCID: PMC4851142 DOI: 10.1590/0102-6720201600010003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/15/2015] [Indexed: 02/08/2023]
Abstract
Background: Liver metastases of colorectal cancer are frequent and potentially fatal event in
the evolution of patients. Aim: In the second module of this consensus, management of resectable liver metastases
was discussed. Method: Concept of synchronous and metachronous metastases was determined, and both
scenarius were discussed separately according its prognostic and therapeutic
peculiarities. Results: Special attention was given to the missing metastases due to systemic
preoperative treatment response, with emphasis in strategies to avoid its
reccurrence and how to manage disappeared lesions. Conclusion: Were presented validated ressectional strategies, to be taken into account in
clinical practice.
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Affiliation(s)
| | | | | | - Paulo Herman
- International Hepato-Pancreato-Biliary Association, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tomas A Aloia
- Americas Hepato-Pancreato-Biliary Association, Brazil
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35
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Personalizing Locoregional Therapy for Patients with Metastatic Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0356-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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36
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Reddy SK, Boland PM, Nurkin SJ. Primary tumor resection does not improve survival among patients with unresectable colorectal cancer metastases-But who determines resectability? Cancer 2017; 123:1089-1091. [PMID: 28178383 DOI: 10.1002/cncr.30595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/15/2016] [Accepted: 01/04/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Srinevas K Reddy
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Patrick M Boland
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Steven J Nurkin
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
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37
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Riechelmann RP, Weschenfelder RF, Costa FP, Andrade AC, Osvaldt AB, Quidute ARP, Dos Santos A, Hoff AAO, Gumz B, Buchpiguel C, Vilhena Pereira BS, Lourenço Junior DM, da Rocha Filho DR, Fonseca EA, Riello Mello EL, Makdissi FF, Waechter FL, Carnevale FC, Coura-Filho GB, de Paulo GA, Girotto GC, Neto JEB, Glasberg J, Casali-da-Rocha JC, Rego JFM, de Meirelles LR, Hajjar L, Menezes M, Bronstein MD, Sapienza MT, Fragoso MCBV, Pereira MAA, Barros M, Forones NM, do Amaral PCG, de Medeiros RSS, Araujo RLC, Bezerra ROF, Peixoto RD, Aguiar S, Ribeiro U, Pfiffer T, Hoff PM, Coutinho AK. Guidelines for the management of neuroendocrine tumours by the Brazilian gastrointestinal tumour group. Ecancermedicalscience 2017; 11:716. [PMID: 28194228 PMCID: PMC5295846 DOI: 10.3332/ecancer.2017.716] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Indexed: 12/13/2022] Open
Abstract
Neuroendocrine tumours are a heterogeneous group of diseases with a significant variety of diagnostic tests and treatment modalities. Guidelines were developed by North American and European groups to recommend their best management. However, local particularities and relativisms found worldwide led us to create Brazilian guidelines. Our consensus considered the best feasible strategies in an environment involving more limited resources. We believe that our recommendations may be extended to other countries with similar economic standards.
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Affiliation(s)
- Rachel P Riechelmann
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Departamento de Radiologia e Oncologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | | | | | | | - Alessandro Bersch Osvaldt
- Hospital Moinhos de Vento de Porto Alegre, Porto Alegre 90035-000, Brasil; Departamento de Cirurgia, Universidade Federal do Rio Grande do Sul, Porto Alegre 90040-060, Brasil; Hospital de Clinicas de Porto Alegre, Porto Alegre 90035-903, Brasil
| | - Ana Rosa P Quidute
- Departamento de Fisiologia e Farmacologia da Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza 60020-180, Brasil; Hospital Universitário Walter Cantidio, Ceará 60430-370, Brasil
| | | | - Ana Amélia O Hoff
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | - Brenda Gumz
- Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | - Carlos Buchpiguel
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Departamento de Radiologia e Oncologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil
| | | | - Delmar Muniz Lourenço Junior
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil
| | | | - Eduardo Antunes Fonseca
- Hospital Sírio-Libanês, São Paulo 01308-050, Brasil; Department of Surgery, AC Camargo Cancer Centre, São Paulo 01509-010, Brasil
| | | | - Fabio Ferrari Makdissi
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Fabio Luiz Waechter
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Brasil
| | - Francisco Cesar Carnevale
- Departamento de Radiologia e Oncologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | - George B Coura-Filho
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil
| | - Gustavo Andrade de Paulo
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Hospital Albert Einstein, São Paulo 05652-900, Brasil
| | - Gustavo Colagiovanni Girotto
- Hospital de Base da Faculdade de Medicina de São José do Rio Preto, São Paulo 15090-000, Brasil; Santa Casa de São José do Rio Preto, São José do Rio Preto 15025-500, Brasil
| | - João Evangelista Bezerra Neto
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | - João Glasberg
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil
| | | | | | | | - Ludhmila Hajjar
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Instituto do Coração, Universidade de São Paulo, São Paulo 05403-900, Brasil
| | - Marcos Menezes
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | - Marcello D Bronstein
- Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil
| | - Marcelo Tatit Sapienza
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Departamento de Radiologia e Oncologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil
| | - Maria Candida Barisson Villares Fragoso
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil
| | | | - Milton Barros
- Medical Oncology, AC Camargo Cancer Centre, São Paulo 01509-010, Brasil
| | - Nora Manoukian Forones
- Disciplina de Gastroenterologia, Universidade Federal de São Paulo, São Paulo 04021-001, Brasil
| | | | | | - Raphael L C Araujo
- Departamento de Cirurgia do Aparelho Digestivo Alto e Hepato-Bilio-Pancreática, Hospital de Câncer de Barretos, São Paulo 14784-400, Brasil
| | | | - Renata D'Alpino Peixoto
- Hospital São José, São Paulo 01323-001, Brasil; Universidade Nove de Julho, São Paulo 02111-030, Brasil
| | - Samuel Aguiar
- Medical Oncology, AC Camargo Cancer Centre, São Paulo 01509-010, Brasil
| | - Ulysses Ribeiro
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Tulio Pfiffer
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | - Paulo M Hoff
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Departamento de Radiologia e Oncologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
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Skipenko OG, Petrenko KN, Bagmet NN, Bedzhanyan AL, Polishchuk LO, Chardarov NK, Shatveryan GA. [Radiofrequency ablation in combined treatment of metastatic colorectal liver cancer]. Khirurgiia (Mosk) 2017:4-18. [PMID: 28091451 DOI: 10.17116/hirurgia2016124-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM To study surgical and oncological outcomes in patients with metastatic colorectal liver cancer who underwent radiofrequency ablation in the structure of combined approach. MATERIAL AND METHODS It is a prospective analysis of treatment of 76 patients with metastatic colorectal liver cancer who underwent RFA for the period 2004-2013. Overall survival was analyzed using univariate and multivariate analysis. RESULTS According to univariate analysis overall 5-year survival is negatively determined by following factors: primary localization of the tumor in rectum (36.2% and 7.2%; p=0.021); bilobed metastatic liver disease (35.9% and 15.4%; p=0.068); metastases dimensions over 5 cm (27.4% and 0%, p=0.091); augmentation of CAE levels over 4 norms (26.7% and 11.4%, p=0.09); RFA as a component of two-stage liver surgery (23.3% and 26.0%, p=0.09). CONCLUSION RFA is an effective method of local antineoplastic effect for metastatic colorectal cancer. Dimensions of coagulated metastases, volume of metastatic lesion, carcinoembryonic antigen level, ablation as a component of two-stage surgery affect long-term survival after RFA.
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Affiliation(s)
- O G Skipenko
- Department of Liver, Biliary and Pancreatic Surgery, Petrovsky Russian Research Center of Surgery, Moscow
| | - K N Petrenko
- Department of Liver, Biliary and Pancreatic Surgery, Petrovsky Russian Research Center of Surgery, Moscow
| | - N N Bagmet
- Department of Liver, Biliary and Pancreatic Surgery, Petrovsky Russian Research Center of Surgery, Moscow
| | - A L Bedzhanyan
- Department of Liver, Biliary and Pancreatic Surgery, Petrovsky Russian Research Center of Surgery, Moscow
| | - L O Polishchuk
- Department of Liver, Biliary and Pancreatic Surgery, Petrovsky Russian Research Center of Surgery, Moscow
| | - N K Chardarov
- Department of Liver, Biliary and Pancreatic Surgery, Petrovsky Russian Research Center of Surgery, Moscow
| | - G A Shatveryan
- Department of Liver, Biliary and Pancreatic Surgery, Petrovsky Russian Research Center of Surgery, Moscow
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Modest DP, Neumann UP, Pratschke J. FOLFOXIRI plus bevacizumab as conversion-therapy for liver metastases in colorectal cancer: A necessity? Eur J Cancer 2017; 73:71-73. [PMID: 28081915 DOI: 10.1016/j.ejca.2016.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Affiliation(s)
- D P Modest
- Department of Medical Oncology & Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximilian-University, Munich, Germany.
| | - U P Neumann
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Aachen, Germany
| | - J Pratschke
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Zampino M, Magni E, Ravenda P, Cella C, Bonomo G, Della Vigna P, Galdy S, Spada F, Varano G, Mauri G, Fazio N, Orsi F. Treatments for colorectal liver metastases: A new focus on a familiar concept. Crit Rev Oncol Hematol 2016; 108:154-163. [DOI: 10.1016/j.critrevonc.2016.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 10/09/2016] [Accepted: 11/13/2016] [Indexed: 11/17/2022] Open
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Meier M, Andersen KJ, Knudsen AR, Nyengaard JR, Hamilton-Dutoit S, Mortensen FV. Liver regeneration is dependent on the extent of hepatectomy. J Surg Res 2016; 205:76-84. [PMID: 27621002 DOI: 10.1016/j.jss.2016.06.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/18/2016] [Accepted: 06/07/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The upper limit for the size of hepatectomy is approximately 90% in rats. The aim of the study was to assess quantitatively using stereological methods the impact on liver function, regeneration rate (RR), and hepatocyte proliferation of varying hepatectomy size in a rat model. MATERIALS AND METHODS A total of 104 male Wistar rats were subjected to 30%, 70%, or 90% partial hepatectomy, sham operation, or no operation. Euthanization and harvesting of liver tissue and blood took place at postoperative days 1, 3, and 5 (n = 8 per group). Liver-specific biochemistry and RR were evaluated. Hepatocyte proliferation was estimated by immunohistochemical staining for Ki-67 antigen using unbiased stereological principles. RESULTS Liver RR in the 90% group increased by a 6.6 fold during the 5 postoperative days compared with only a minor increase in both the 70% and 30% partial hepatectomy groups. The highest number of Ki-67-positive hepatocytes was observed in the 70% group at postoperative day 1 and for the 90% group at postoperative day 3. Prothrombin-proconvertin ratio was significantly lower in the 90% group 1 d after surgery compared with all other groups, however, nearly normalized at postoperative day 5. CONCLUSIONS We show that liver RR and the number of proliferating hepatocytes increase, whereas the initial hepatic synthetic capacity decreases with increasing hepatectomy size.
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Affiliation(s)
- Michelle Meier
- Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
| | | | | | - Jens Randel Nyengaard
- Stereology & Electron Microscopy Laboratory, Centre for Stochastic Geometry and Advanced Bioimaging, Aarhus University Hospital, Aarhus, Denmark
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Dervenis C, Xynos E, Sotiropoulos G, Gouvas N, Boukovinas I, Agalianos C, Androulakis N, Athanasiadis A, Christodoulou C, Chrysou E, Emmanouilidis C, Georgiou P, Karachaliou N, Katopodi O, Kountourakis P, Kyriazanos I, Makatsoris T, Papakostas P, Papamichael D, Pechlivanides G, Pentheroudakis G, Pilpilidis I, Sgouros J, Tekkis P, Triantopoulou C, Tzardi M, Vassiliou V, Vini L, Xynogalos S, Ziras N, Souglakos J. Clinical practice guidelines for the management of metastatic colorectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO). Ann Gastroenterol 2016; 29:390-416. [PMID: 27708505 PMCID: PMC5049546 DOI: 10.20524/aog.2016.0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 03/10/2016] [Indexed: 12/12/2022] Open
Abstract
There is discrepancy and failure to adhere to current international guidelines for the management of metastatic colorectal cancer (CRC) in hospitals in Greece and Cyprus. The aim of the present document is to provide a consensus on the multidisciplinary management of metastastic CRC, considering both special characteristics of our Healthcare System and international guidelines. Following discussion and online communication among the members of an executive team chosen by the Hellenic Society of Medical Oncology (HeSMO), a consensus for metastastic CRC disease was developed. Statements were subjected to the Delphi methodology on two voting rounds by invited multidisciplinary international experts on CRC. Statements reaching level of agreement by ≥80% were considered as having achieved large consensus, whereas statements reaching 60-80% moderate consensus. One hundred and nine statements were developed. Ninety experts voted for those statements. The median rate of abstain per statement was 18.5% (range: 0-54%). In the end of the process, all statements achieved a large consensus. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized. R0 resection is the only intervention that may offer substantial improvement in the oncological outcomes.
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Affiliation(s)
- Christos Dervenis
- General Surgery, "Konstantopouleio" Hospital of Athens, Greece (Christos Dervenis)
| | - Evaghelos Xynos
- General Surgery, "InterClinic" Hospital of Heraklion, Greece (Evangelos Xynos)
| | | | - Nikolaos Gouvas
- General Surgery, "METROPOLITAN" Hospital of Piraeus, Greece (Nikolaos Gouvas)
| | - Ioannis Boukovinas
- Medical Oncology, "Bioclinic" of Thessaloniki, Greece (Ioannis Boukovinas)
| | - Christos Agalianos
- General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, Ioannis Kyriazanos, George Pechlivanides)
| | - Nikolaos Androulakis
- Medical Oncology, "Venizeleion" Hospital of Heraklion, Greece (Nikolaos Androulakis)
| | | | | | - Evangelia Chrysou
- Radiology, University Hospital of Heraklion, Greece (Evangelia Chrysou)
| | - Christos Emmanouilidis
- Medical Oncology, "Interbalkan" Medical Center, Thessaloniki, Greece (Christos Emmanoulidis)
| | - Panagiotis Georgiou
- Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK (Panagiotis Georgiou, Paris Tekkis)
| | - Niki Karachaliou
- Medical Oncology, Dexeus University Institut, Barcelona, Spain (Niki Carachaliou)
| | - Ourania Katopodi
- Medical Oncology, "Iaso" General Hospital, Athens, Greece (Ourania Katopoidi)
| | - Panteleimon Kountourakis
- Medical Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Pandelis Kountourakis, Demetris Papamichael)
| | - Ioannis Kyriazanos
- General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, Ioannis Kyriazanos, George Pechlivanides)
| | - Thomas Makatsoris
- Medical Oncology, University Hospital of Patras, Greece (Thomas Makatsoris)
| | - Pavlos Papakostas
- Medical Oncology, "Ippokrateion" Hospital of Athens, Greece (Pavlos Papakostas)
| | - Demetris Papamichael
- Medical Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Pandelis Kountourakis, Demetris Papamichael)
| | - George Pechlivanides
- General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, Ioannis Kyriazanos, George Pechlivanides)
| | | | - Ioannis Pilpilidis
- Gastroenterology, "Theageneion" Cancer Hospital, Thessaloniki, Greece (Ioannis Pilpilidis)
| | - Joseph Sgouros
- Medical Oncology, "Agioi Anargyroi" Hospital of Athens, Greece (Joseph Sgouros)
| | - Paris Tekkis
- Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK (Panagiotis Georgiou, Paris Tekkis)
| | | | - Maria Tzardi
- Pathology, University Hospital of Heraklion, Greece (Maria Tzardi)
| | - Vassilis Vassiliou
- Radiation Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Vassilis Vassiliou)
| | - Louiza Vini
- Radiation Oncology, "Iatriko" Center of Athens, Greece (Lousa Vini)
| | - Spyridon Xynogalos
- Medical Oncology, "George Gennimatas" General Hospital, Athens, Greece (Spyridon Xynogalos)
| | - Nikolaos Ziras
- Medical Oncology, "Metaxas" Cancer Hospital, Piraeus, Greece (Nikolaos Ziras)
| | - John Souglakos
- Medical Oncology, University Hospital of Heraklion, Greece (John Souglakos)
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Herman P, Krüger JAP, Perini MV, Coelho FF, Cecconello I. High Mortality Rates After ALPPS: the Devil Is the Indication. J Gastrointest Cancer 2016; 46:190-4. [PMID: 25682120 DOI: 10.1007/s12029-015-9691-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Paulo Herman
- Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Rua Dr. Enéas de Carvalho Aguiar, 255 - 9° andar - sala 9025, São Paulo, SP, CEP 05403-900, Brazil
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Foo EW, Moore T, Harris D, Yi M, Connor S. Long-term outcomes of hepatic resection for colorectal liver metastases at a New Zealand tertiary level public hospital. ANZ J Surg 2016; 86:285-8. [DOI: 10.1111/ans.13468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Elizabeth W. Foo
- Department of General Surgery; Christchurch Hospital, Canterbury District Health Board; Christchurch New Zealand
| | - Tom Moore
- Department of Medical Oncology; Christchurch Hospital, Canterbury District Health Board; Christchurch New Zealand
| | - Dean Harris
- Department of Medical Oncology; Christchurch Hospital, Canterbury District Health Board; Christchurch New Zealand
| | - Ma Yi
- Biostatistics; Christchurch Hospital, Canterbury District Health Board; Christchurch New Zealand
| | - Saxon Connor
- Department of General Surgery; Christchurch Hospital, Canterbury District Health Board; Christchurch New Zealand
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Coelho FF, Kruger JAP, Fonseca GM, Araújo RLC, Jeismann VB, Perini MV, Lupinacci RM, Cecconello I, Herman P. Laparoscopic liver resection: Experience based guidelines. World J Gastrointest Surg 2016; 8:5-26. [PMID: 26843910 PMCID: PMC4724587 DOI: 10.4240/wjgs.v8.i1.5] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/07/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers’ practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.
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Zaydfudim VM, McMurry TL, Harrigan AM, Friel CM, Stukenborg GJ, Bauer TW, Adams RB, Hedrick TL. Improving treatment and survival: a population-based study of current outcomes after a hepatic resection in patients with metastatic colorectal cancer. HPB (Oxford) 2015; 17:1019-24. [PMID: 26353888 PMCID: PMC4605341 DOI: 10.1111/hpb.12488] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/01/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Population-based studies historically report underutilization of a resection in patients with colorectal metastases to the liver. Recent data suggest limitations of the methods in the historical analysis. The present study examines trends in a hepatic resection and survival among Medicare recipients with hepatic metastases. METHODS Medicare recipients with incident colorectal cancer diagnosed between 1991 and 2009 were identified in the SEER(Surveillance, Epidemiology and End Results)-Medicare dataset. Patients were stratified into historical (1991-2001) and current (2002-2009) cohorts. Analyses compared treatment, peri-operative outcomes and survival. RESULTS Of 31.574 patients with metastatic colorectal cancer to the liver, 14,859 were in the current cohort treated after 2002 and 16,715 comprised the historical control group. The overall proportion treated with a hepatic resection increased significantly during the study period (P < 0.001) with pre/post change from 6.5% pre-2002 to 7.5% currently (P < 0.001). Over time, haemorrhagic and infectious complications declined (both P ≤ 0.047), but 30-day mortality was similar (3.5% versus 3.9%, P = 0.660). After adjusting for predictors of survival, the use of a hepatic resection [hazard ratio (HR) = 0.40, 95% confidence interval (CI): 0.38-0.42, P < 0.001] and treatment after 2002 (HR = 0.88, 95% CI: 0.86-0.90, P < 0.001) were associated with a reduced risk of death. CONCLUSIONS Case identification using International Classification of Diseases, 9th Revision (ICD-9) codes is imperfect; however, comparison of trends over time suggests an improvement in multimodality therapy and survival in patients with colorectal metastases to the liver.
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Affiliation(s)
- Victor M Zaydfudim
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of VirginiaCharlottesville, VA, USA,Surgical Outcomes Research Center, University of VirginiaCharlottesville, VA, USA
| | - Timothy L McMurry
- Surgical Outcomes Research Center, University of VirginiaCharlottesville, VA, USA,Department of Public Health Sciences, University of VirginiaCharlottesville, VA, USA
| | - Amy M Harrigan
- Surgical Outcomes Research Center, University of VirginiaCharlottesville, VA, USA,Section of Colorectal Surgery, Department of Surgery, University of VirginiaCharlottesville, VA, USA
| | - Charles M Friel
- Section of Colorectal Surgery, Department of Surgery, University of VirginiaCharlottesville, VA, USA
| | - George J Stukenborg
- Surgical Outcomes Research Center, University of VirginiaCharlottesville, VA, USA,Department of Public Health Sciences, University of VirginiaCharlottesville, VA, USA
| | - Todd W Bauer
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of VirginiaCharlottesville, VA, USA
| | - Reid B Adams
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of VirginiaCharlottesville, VA, USA
| | - Traci L Hedrick
- Surgical Outcomes Research Center, University of VirginiaCharlottesville, VA, USA,Section of Colorectal Surgery, Department of Surgery, University of VirginiaCharlottesville, VA, USA
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Al-Sharif E, Simoneau E, Hassanain M. Portal vein embolization effect on colorectal cancer liver metastasis progression: Lessons learned. World J Clin Oncol 2015; 6:142-146. [PMID: 26468450 PMCID: PMC4600188 DOI: 10.5306/wjco.v6.i5.142] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/07/2015] [Accepted: 07/27/2015] [Indexed: 02/06/2023] Open
Abstract
Colorectal liver metastasis (CRLM) is the major cause of death in patients diagnosed with colorectal cancer. The gold standard treatment of CRLM is surgical resection. Yet, in the past, more than half of these patients were deemed unresectable due to the inadequate future liver remnant (FLR). The introduction of efficient portal vein embolization (PVE) preoperatively allowed more resections of metastasis in CRLM patients by stimulating adequate liver hypertrophy. However, several experimental and clinical studies reported tumor progression after PVE which critically influences the subsequent management of these patients. The underlying pathophysiological mechanism of tumor progression post-PVE is still not fully understood. In spite of the adverse effects of PVE, it remains a potentially curative procedure in patients who would remain otherwise unresectable because of the insufficient FLR. Currently, the challenge is to halt tumor proliferation following PVE in patients who require this technique. This could potentially be achieved by either attempting to suppress the underlying oncologic stimulus or by inhibiting tumor growth once observed after PVE, without jeopardizing liver regeneration. More research is still required to better identify patients at risk of experiencing tumor growth post-PVE.
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Hepatic artery infusion therapy is effective for chemotherapy-resistant liver metastatic colorectal cancer. World J Surg Oncol 2015; 13:296. [PMID: 26452624 PMCID: PMC4600220 DOI: 10.1186/s12957-015-0704-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/22/2015] [Indexed: 12/31/2022] Open
Abstract
Background Systemic FOLFOX (folinic acid (leucovorin (LV)), 5-fluorouracil (5-FU), and oxaliplatin), FOLFIRI (LV, 5-FU, and irinotecan), or FOLFOXIRI (5-FU, leucovorin, oxaliplatin, and irinotecan) chemotherapy regimens and additional molecular-target treatments, including anti-vascular endothelial growth factor, anti-epidermal growth factor receptor, and anti-multi-kinase antibodies, have been recommended for unresectable recurrent colorectal cancers. However, no effective treatments are currently available for cases refractory to these therapies. Therefore, the development of alternative therapies is desired. In the present study, we administered and observed the effectiveness of hepatic artery infusion therapy (HAIC) in patients with unresectable liver metastatic colorectal cancers refractory to systemic chemotherapy. In addition, we observed that in an experimental system with anticancer drug-resistant colorectal cancer lines, apoptosis and cell death could be induced by increasing anticancer drug concentrations. Methods The subjects had liver metastatic colorectal cancers that were unresponsive to systemic chemotherapy (FOLFOX/FOLFIRI) or to additional molecular-target therapies for progressive disease. Hepatic infusion tube placement was conducted according to the Seldinger method to insert a catheter with a side hole via the right femoral artery. A coiling procedure was performed to prevent drug influx into the gastroduodenal artery. Ten subjects were selected, and the results were evaluated after HAIC (5-FU and LV administered once weekly). Moreover, anticancer drug-resistant colorectal cancer lines were subsequently prepared to investigate whether increased anticancer drug concentrations could induce apoptosis or cell death. Results Of the 10 subjects, 3 (30 %) showed partial response and 4 (40 %) showed no change according to computed tomography imaging findings obtained after hepatic artery infusion. The disease control rate was 70 %. Eight subjects had improved quality of life. Survival time ranged from 2 to 16 months (median, 9 months). Meanwhile, we found that higher anticancer drug concentrations induced apoptosis and cell death in an anticancer drug-resistant colorectal cancer cell line. Conclusions HAIC was effective in some systemic chemotherapy-resistant colorectal cancers with liver metastases and should be considered as an effective palliative therapy. This supports the finding that apoptosis and cell death could be induced in anticancer drug-resistant colorectal cancer cells in a drug concentration-dependent manner.
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Qadan M, D'Angelica MI. Complex Surgical Strategies to Improve Resectability in Borderline-Resectable Disease. CURRENT COLORECTAL CANCER REPORTS 2015; 11:369-377. [PMID: 28090195 DOI: 10.1007/s11888-015-0290-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colorectal cancer is the third most common malignancy in the USA and continues to pose a significant epidemiologic problem, despite major advances in the treatment of patients with advanced disease. Up to 50 % of patients will develop metastatic disease at some point during the course of their disease, with the liver being the most common site of metastatic disease. In this review, we address the relatively poorly defined entity of borderline-resectable colorectal liver metastases. The workup and staging of borderline-resectable disease are discussed. We then discuss management strategies, including surgical techniques and medical therapies, which are currently utilized in order to improve resectability.
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Affiliation(s)
- Motaz Qadan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C898, New York, NY 10065, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C898, New York, NY 10065, USA
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Karanicolas PJ, Ko YJ. Transarterial Therapy for Primary Liver Carcinomas: A Crack in the Armor? Ann Surg Oncol 2015; 22:4111-2. [PMID: 26228107 DOI: 10.1245/s10434-015-4776-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Paul J Karanicolas
- Department of Surgery, The Odette Cancer Centre at Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Department of Surgery, University of Toronto, Toronto, Canada.
| | - Yoo-Joung Ko
- Division of Medical Oncology, The Odette Cancer Centre at Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
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