Synchronous colorectal liver metastases: a national survey of surgeon opinions on simultaneous resection and multidisciplinary cooperation

Health-Related Quality of Life Following Simultaneous Resection for Synchronous Colorectal Cancer Liver Metastases

INTRODUCTION

Up to 25% of colorectal cancer patients present with synchronous liver metastases that can be treated with two operations or a single 'simultaneous' operation. Morbidity and mortality appear similar between approaches, however changes in health-related quality-of-life following simultaneous resection are not well reported.

METHODS

A prospective, feasibility trial for simultaneous resection of synchronous colorectal liver metastases was conducted. Patients completed the European Organization for Research and Treatment of Cancer QLQ-C30 and LMC21 at baseline (preoperatively), and 4 and 12 weeks postoperatively. Week 4 and 12 scores were compared with baseline using t-tests. Minimally important clinical differences were considered as a 10-point difference from baseline.

RESULTS

C30 and QLQ-LMC21 were completed at baseline, 4 weeks, and 12 weeks by 39 (95%), 35 (85%) and 34 (83%) patients, and 39 (95%), 33 (80%) and 33 (80%) patients, respectively; 79% and 75% had at least one MICD according to QLQ-C30 at 4 and 12 weeks. At 4 weeks, physical functioning (mean difference (MD) - 11.9%, p = 0.002), role functioning (MD - 23.6, p = 0.007), and pain (MD + 19.7, p = 0.017) had significant worsening from baseline. At 12 weeks postoperatively, role functioning (MD - 19.7, p = 0.011) and fatigue (MD + 14.3, p = 0.03) were the only domains that remained significantly worse. By 12 weeks, pain and physical functioning had returned to baseline. There were no major demographic differences among those with and without an MICD at 12 weeks.

CONCLUSIONS

Simultaneous resection of colorectal liver metastases led to clinically significant worsening fatigue and role functioning that persisted at 12 weeks post-surgery.

Thermal ablation versus hepatic resection for colorectal cancer with synchronous liver metastases: a propensity score matching study

OBJECTIVES

Several studies have compared the efficacy of hepatic resection (HR) and thermal ablation (TA) for unresectable tumors; however, results remain inconsistent. Most cohorts in previous studies were heterogeneous groups of synchronous colorectal liver metastases (CRLM) and extrahepatic metastases. This retrospective study aimed to compare the therapeutic efficacy between TA and HR in synchronous CRLM without extrahepatic metastases.

METHODS

Cases with initially synchronous CRLM without extrahepatic metastases between January 2007 and December 2018 were enrolled. Of the 448 cases, 346 received HR and 102 TA. Propensity score matching with a 1:1 ratio was used to improve the comparability between the HR and TA groups. Technical success, complications, disease-free survival (DFS), and overall survival (OS) were compared before and after matching.

RESULTS

All patients achieved technical success. Major complication rates in the HR and TA groups were, respectively, 36.7% and 8.8% (p < 0.001). Before matching, the 5-year OS and DFS (p = 0.004 and p = 0.020, respectively) were significantly higher in the HR group than in the TA group. After matching, no significant difference in the 5-year OS and DFS was found between the groups (p = 0.770 and p = 0.939, respectively). Local tumor progression rate was significantly higher in the TA group both before (p = 0.027) and after (p = 0.029) matching.

CONCLUSIONS

For patients with CRC with synchronous CRLM, TA and HR provide comparable OS and DFS. TA is preferable if complete ablation is predicted.

KEY POINTS

• Thermal ablation and hepatic resection provide comparable overall survival and disease-free survival. • Thermal ablation is a safe and effective treatment for patients with colorectal cancer with synchronous liver metastases and has a lower major complication rate and higher repeatability than hepatic resection. • Thermal ablation is preferable if complete ablation is predicted.

Attitudes of Canadian Colorectal Cancer Care Providers towards Liver Transplantation for Colorectal Liver Metastases: A National Survey

Up to 50% of colorectal cancer (CRC) patients develop colorectal liver metastases (CRLM). The aim of this study was to gauge the awareness and perception of liver transplantation (LT) for non-resectable CRLM, and to describe the current referral patterns and management strategies for CRLM in Canada. Surgeons who provide care for patients with CRC were invited to an online survey through the Canadian Association of General Surgeons, the Canadian Society of Colon and Rectal Surgeons, and the Canadian Society of Surgical Oncology. Thirty-seven surveys were included. The most utilized management strategy for CRLM was to refer to a hepatobiliary surgeon for assessment of metastectomy (78%), and/or refer to medical oncologists for consideration of chemotherapy (73%). Among the respondents, 84% reported that their level of knowledge about LT for CRLM was low, yet the perception of exploring the option of LT for non-resectable CRLM seemed generally favorable (81%). The decision to refer for consideration of LT for CRLM treatment seemed to depend on patient-specific factors and the local hepatobiliary surgeon’s recommendation. Providing CRC care providers with educational materials on up-to-date CRLM management may help raise the awareness of the use of LT for non-resectable CRLM.

Evolutions of the Management of Colorectal Cancer Liver Metastasis: A Bibliometric Analysis

Background: Tremendous progress has been made in the treatment of colorectal cancer liver metastasis (CRCLM) in recent decades, and thousands of papers have been published. Therefore, we conducted a bibliometric analysis of articles related to CRCLM treatment to explore its evolution. Materials and Methods: The Clarivate Analytics Web of Science (WOS) Core Collection database was searched through June 2020 using terms related to CRCLM treatment. We analyzed the bibliographic information of the literature related to CRCLM treatment and explored the research topics to understand its evolution over time. Results: We identified 3436 records related to CRCLM treatment in the WOS database. The total number of times these documents were cited ranged 0-2352, and the years of publication spanned 1976-2020. The greatest numbers of articles were published in the United States, Japan, and France. Among institutions, Memorial Sloan-Kettering Cancer Center, MD Anderson Cancer Center, and Oslo University Hospital published the most articles. Regarding authors, Jarnagin WR, Adam R, Vauthey JN published the most articles. The research topics of these articles included systemic chemotherapy, molecular targeted therapy, the outcome of liver resection, prognosis prediction, hepatic artery infusion, radiofrequency ablation, and two-stage hepatectomy. Conclusion: Bibliometric analysis of studies related to CRCLM treatment can help doctors and researchers quickly understand the development trend in this field. These data emphasize the current management of patients with CRCLM, and they can potentially guide the direction of future research.

Simultaneous resection of colorectal cancer with synchronous liver metastases; a practice survey

BACKGROUND

We examined surgeon practice intentions and barriers to performing simultaneous resections for colorectal cancer with synchronous liver metastases.

METHODS

We electronically surveyed North American surgeons who provide colorectal cancer care with a pilot-tested questionnaire. Four clinical scenarios of increasing complexity were presented. Perceived outcomes of and barriers to simultaneous resection were assessed on a 7-point Likert scale. We compared results between general and hepatobiliary surgeons.

RESULTS

Responses (rate 20%, 234/1166) included 50 general and 134 hepatobiliary surgeons. High likelihood scores for support of simultaneous resection among general and hepatobiliary surgeons, respectively, included the following for: minor liver and low complexity colon, 83% and 98% (p < 0.001); minor liver and rectal resection, 57% and 73% (p = 0.042); complex liver and low complexity colon resection, 26% and 24% (p = 0.858); and, complex liver and rectal resection, 11% and 7.0% (p = 0.436). Among hepatobiliary surgeons, the most common barriers to simultaneous resections were patient comorbidities and lung metastases, whereas certain general surgeons additionally identified transfer of care.

CONCLUSIONS

Surgeon support for simultaneous resection was high for cases with minor hepatectomy, and low for cases involving major hepatectomy. These results suggest that clinical trials should involve patients with limited disease to evaluate post-operative complications and cost.

Prognostic value of sarcopenia in patients with colorectal liver metastases undergoing hepatic resection

The prognostic significance of sarcopenia has been widely studied in different cancer patients. This study aimed to analyze the influence of sarcopenia on long-term survival in patients with colorectal liver metastasis (CRLM) undergoing hepatic resection. A retrospective analysis of 182 patients undergoing hepatic resection for CRLM was performed. Sarcopenia was determinedusing the Hounsfield unit average calculation (HUAC), a measure of muscle quality-muscledensity at preoperative abdominal computed tomography scans. Sarcopenia was defined as an HUAC score of less than 22 HU calculated using receiver operating characteristic analysis. The prognostic relevance of clinical variables and overall survival (OS) and recurrence-free survival (RFS) was evaluated. Patients with sarcopenia were older (p < 0.001) and had higher prevalence of diabetics (p = 0.004), higher body mass index (BMI) (p < 0.001) and neutrophil-to-lymphocyte ratio (p = 0.026) compared to those without. Sarcopenia was not significantly associated with OS and RFS. Multivariate Cox’s regression analysis showed that multinodularity (>3) (hazard ratio (HR) 2.736; 95% confidence interval (CI), 1.631–4.589; p < 0.001), high CEA level (≥20 ng/ml) (HR 1.793; 95% CI, 1.092–2.945; p = 0.021) and blood loss (≥300 cc) (HR1.793; 95% CI, 1.084–2.964; p = 0.023) were independent factors associated with OS. In subgroup analyses, sarcopenia was a significant factor of poor OS in the patients with multinodularity by univariate (p = 0.002) and multivariate analyses(HR 3.571; 95% CI, 1.508–8.403; p = 0.004). Multinodularity (>3) (HR 1.750; 95% CI, 1.066–2.872; p = 0.027), high aspartate aminotransferase level (HR 1.024; 95% CI, 1.003–1.046; p = 0.025) and male gender (HR 1.688; 95% CI, 1.036–2.748; p = 0.035) were independent factors of RFS. In conclusion, despite no significance in whole cohort, sarcopenia was predictive of worse OS in patients with multiple CRLM after partial hepatectomy.