The neoadjuvant therapy of colorectal hepatic metastases and the role of biologic sensitizing and resistance factors

Effects of chronic liver disease on the outcomes of simultaneous resection of colorectal cancer with synchronous liver metastases: a propensity score matching study

Introduction

Given the rising prevalence of chronic liver disease (CLD), it is increasingly important to understand its impact on surgical outcomes. Our aim was to evaluate the impact of CLD on short-term outcomes in patients with colorectal cancer and synchronous liver metastases undergoing simultaneous surgery.

Methods

We retrospectively reviewed patients with colorectal cancer and liver metastases who underwent simultaneous resection between January 2013 and June 2022. Patients were divided into the CLD and non-CLD groups. Data regarding short-term surgical outcomes were compared between the two groups.

Results

A total of 187 patients were included. After propensity score matching, there were 42 patients in each group, and the basic characteristics of the two groups were similar. Patients with CLD had a significantly greater incidence of postoperative complications (47.6% vs. 26.2%; P = 0.042). The operation times of the CLD and non-CLD groups were similar (297 vs. 307.5 min, P = 0.537), and the blood loss was comparable between the two groups (250 vs. 155 ml, P = 0.066). No significant differences were observed between the two groups in pneumonia (P > 0.999), urinary infection rate (P > 0.999), ileus rate (P = 0.474), wound infection rates (P > 0.999), abdominal infection rate (P = 0.533), anastomotic leakage rate (P > 0.999), digestive hemorrhage rate (P > 0.999), bile leakage rate (P > 0.999), hepatic hemorrhage rate (P > 0.999), reoperation rate (P > 0.999), intensive care rate (P > 0.999), or severe liver failure (P > 0.999). There were no deaths in the two groups. CLD significantly prolonged the length of hospital stay (P = 0.011).

Discussion

CLD is an important factor affecting postoperative complications in patients with colorectal cancer liver metastases undergoing simultaneous surgery. Considering the large number of patients with CLD in China, more attention and medical care should be provided to patients with CLD who require simultaneous resection of colorectal cancer with synchronous liver metastases.

Impact of slice thickness on semi-automated measurements for volume and whole-tumor attenuation of colorectal hepatic metastases in multislice computed tomography

BACKGROUND

Volumetric and whole-tumor attenuation assessment of tumor are of value in assessment of treatment.

PURPOSE

To assess the impact of slice thickness on semi-automatic analyses (volume, whole-tumor attenuation) for small colorectal hepatic metastases.

MATERIAL AND METHODS

Computed tomography (CT) data of patients with colorectal hepatic metastases at 1.5-, 3-, and 5-mm slice thickness were semi-automatically evaluated for volume and whole-tumor attenuation by two radiologists independently. Statistical analysis included paired samples t-test and concordance correlation coefficient (CCC) analysis according to the longest axial tumor diameter (10-20 mm, 20-30 mm, 30-40 mm).

RESULTS

A total of 62 patients (32 men and 30 women) with 62 target tumors were included. The mean volume was significantly higher at 3- and 5-mm slice thicknesses in comparison with the reference (1.5 mm) for the target tumors between 10 mm and 20 mm (P = 0.0295, CCC = 0.9394 for 3 mm; P = 0.0029, CCC = 0.5129 for 5 mm, respectively) and at 5 mm slice thickness for the target tumors between 20 mm and 30 mm (P = 0.0071, CCC = 0.9102). For whole-tumor attenuation measurements, the significant difference was only seen at 5-mm slice thicknesses in comparison with the reference (1.5 mm) for the target tumors between 10 and 20 mm (P = 0.0015, CCC = 0.9389).

CONCLUSION

Slice thickness of 1.5 mm might be suggested for semi-automated volumetric measurements, and slice thickness of no more than 3 mm for whole-tumor CT attenuation in hepatic metastasis between 10 mm and 20 mm.

Is neoadjuvant chemotherapy necessary for patients with initially resectable colorectal liver metastases in the era of effective chemotherapy?

Backgrounds/Aims

Hepatic resection has only guaranteed long-term survival in patients with colorectal liver metastasis (CRLM) even in the era of effective chemotherapy. The definite role of neoadjuvant chemotherapy (NCT) is to improve outcomes of unresectable CRLMs, but it its role has not been defined for initially resectable CRLMs (IR-CRLMs).

Methods

We reviewed the medical records of 226 patients, who had been diagnosed and treated for IR-CRLM between 2003 and 2008; the patients had the following pathologies: 10% had more than 4 nodules, 11% had tumors larger than 5 cm, and 61% had synchronous CRMLs. Among these patients, 20 patients (Group Y) were treated with NCT, and 206 (Group N) did not receive NCT according to their physician's preference. The median follow-up time was 34.1 months.

Results

The initial surgical plans were changed after NCT to further resection in 20% and to limited resection in 10% of 20 patients. Complication rates of Groups Y (30%) were indifferent from Group N (23%) (p=0.233), but intraoperative transfusions were more frequent in Group N (15%) than in Group Y (5%) (p=0.006). There was one case of hospital mortality (0.44%). Disease-free survival rates in Groups Y and N were 23% and 39%, respectively, and patient survival rates were 42% and 66% (p>0.05). By multivariate analysis, old age (≥60 years), differentiation of primary tumor (poorly/mucinous), resection margin involvement, and no adjuvant chemotherapy were associated with poor patient survival; the number of CRLMs (≥4) was associated with poor disease-free survival.

Conclusions

NCT had neither a positive impact nor a negative impact on survival, even with intraoperative transfusion, as observed on operative outcomes for patients with IR-CRLM. Further study is required to elucidate the role of NCT for treatment of patient with IR-CRLMs.

Single-Incision Laparoscopic Liver Resection for Colorectal Metastasis through Stoma Site at Time of Reversal of Diversion Ileostomy: A Case Report. Minim Invasive Surg. 2011;2011:502176. [PMID: 22091359 PMCID: PMC3196974 DOI: 10.1155/2011/502176]

Minimally invasive surgical techniques for liver tumors are gaining increased acceptance as an alternative to traditional resections by laparotomy. In this article we describe a laparoscopic liver resection of a metastatic lesion in a patient primarily operated for colorectal cancer. The resection was conducted as a single port procedure through the stoma aperture at time of reversal of the diversion ileostomy. Sigle incision liver resections may be less traumatic than conventional laparoscopy and could be applied in selected patients with both benign and malignant liver tumors.