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Liver Resection for Metastatic Colorectal Cancer in the Presence of Extrahepatic Disease

  • Controversies in the Management of Hepatic Colorectal Metastases
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Hepatic resection for metastatic colorectal cancer (CRC) with concomitant extrahepatic disease (EHD) is controversial. Earlier reports of the results of liver resection for metastatic CRC identified patients with EHD as a group with poor outcomes, suggesting that the presence of EHD was an absolute contraindication to resection. This has recently been challenged in several reports due to advances in systemic chemotherapy, surgical technique, and patient selection.

Methods

This review was restricted to published data in the English language identified by searches of MEDLINE and Pubmed databases as well as reference lists of recent review articles on subjects of surgery for metastatic colorectal cancer.

Results

Five-year survival after resection is worse than patients with liver-only disease but approximates the survival rates seen in patients with resected liver-only metastases in the era prior to the use of modern chemotherapy. Recurrence occurs in the great majority of patients.

Conclusions

At this time, there appears to be a role for surgery in highly selected patients with a single site of EHD amenable to complete resection. Unlike patients with liver-only disease, however, the goals of surgery must not be viewed as potentially curative.

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References

  1. Tomlinson JS, Jarnagin WR, DeMatteo RP, Fong Y, Kornprat P, Gonen M, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25(29):4575–80.

    Article  PubMed  Google Scholar 

  2. Adson MA, van Heerden JA, Adson MH, Wagner JS, Ilstrup DM. Resection of hepatic metastases from colorectal cancer. Arch Surg. 1984;119(6):647–51.

    PubMed  CAS  Google Scholar 

  3. Ekberg HH, Tranberg KKG, Andersson RR, Lundstedt CC, Hägerstrand II, Ranstam JJ, et al. Determinants of survival in liver resection for colorectal secondaries. Br J Surg. 1986;73(9):727–31.

    Article  PubMed  CAS  Google Scholar 

  4. Hughes KS, Simon R, Songhorabodi S, Adson MA, Ilstrup DM, Fortner JG, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence. Surgery. 1986;100(2):278–84.

    PubMed  CAS  Google Scholar 

  5. Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239(6):818–25; discussion 825–7.

    Article  PubMed  Google Scholar 

  6. Blumgart LLH, Fong YY. Surgical options in the treatment of hepatic metastasis from colorectal cancer. Curr Prob Surg. 1995;32(5):333–421.

    Article  CAS  Google Scholar 

  7. August DA, Sugarbaker PH, Schneider PD. Lymphatic dissemination of hepatic metastases. Implications for the follow-up and treatment of patients with colorectal cancer. Cancer. 1985;55(7):1490–4.

    Article  PubMed  CAS  Google Scholar 

  8. Beckurts KT, Holscher AH, Thorban S, Bollschweiler E, Siewert JR. Significance of lymph node involvement at the hepatic hilum in the resection of colorectal liver metastases. Br J Surg. 1997;84(8):1081–4.

    Article  PubMed  CAS  Google Scholar 

  9. Rosen CB, Nagorney DM, Taswell HF, Helgeson SL, Ilstrup DM, van Heerden JA, et al. Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma. Ann Surg. 1992;216(4):493–504; discussion 504–5.

    Article  PubMed  CAS  Google Scholar 

  10. Kokudo N, Sato T, Seki M, Ohta H, Azekura K, Ueno M, et al. Hepatic lymph node involvement in resected cases of liver metastases from colorectal cancer. Dis Colon Rectum. 1999;42(10):1285–90; discussion 1290–1.

    Article  PubMed  CAS  Google Scholar 

  11. Jaeck D, Nakano H, Bachellier P, Inoue K, Weber JC, Oussoultzoglou E, et al. Significance of hepatic pedicle lymph node involvement in patients with colorectal liver metastases: a prospective study. Ann Surg Oncol. 2002;9(5):430–8.

    Article  PubMed  Google Scholar 

  12. Elias D, Saric J, Jaeck D, Arnaud JP, Gayet B, Rivoire M, et al. Prospective study of microscopic lymph node involvement of the hepatic pedicle during curative hepatectomy for colorectal metastases. Br J Surg. 1996;83(7):942–5.

    Article  PubMed  CAS  Google Scholar 

  13. Ercolani G, Grazi GL, Ravaioli M, Grigioni WF, Cescon M, Gardini A, et al. The role of lymphadenectomy for liver tumors: further considerations on the appropriateness of treatment strategy. Ann Surg. 2004;239(2):202–9.

    Article  PubMed  Google Scholar 

  14. Grobmyer SR, Wang L, Gonen M, Fong Y, Klimstra D, D'Angelica M, et al. Perihepatic lymph node assessment in patients undergoing partial hepatectomy for malignancy. Ann Surg. 2006;244(2):260–4.

    Article  PubMed  Google Scholar 

  15. Laurent C, Sa Cunha A, Rullier E, Smith D, Rullier A, Saric J. Impact of microscopic hepatic lymph node involvement on survival after resection of colorectal liver metastasis. J Am Coll Surg. 2004;198(6):884–91.

    Article  PubMed  Google Scholar 

  16. Adam R, de Haas RJ, Wicherts DA, Aloia TA, Delvart V, Azoulay D, et al. Is hepatic resection justified after chemotherapy in patients with colorectal liver metastases and lymph node involvement? J Clin Oncol. 2008;26(22):3672–80.

    Article  PubMed  Google Scholar 

  17. Tan LK, Giri D, Hummer AJ, Panageas KS, Brogi E, Norton L, et al. Occult axillary node metastases in breast cancer are prognostically significant: results in 368 node-negative patients with 20-year follow-up. J Clin Oncol. 2008;26(11):1803–9.

    Article  PubMed  Google Scholar 

  18. Bennett JJ, Schmidt CR, Klimstra DS, Grobmyer SR, Ishill NM, D'Angelica M, et al. Perihepatic lymph node micrometastases impact outcome after partial hepatectomy for colorectal metastases. Ann Surg Oncol. 2008;15(4):1130–6.

    Article  PubMed  Google Scholar 

  19. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230(3):309–18; discussion 318–21.

    Article  PubMed  CAS  Google Scholar 

  20. Higashiyama M, Kodama K, Higaki N, Takami K, Murata K, Kameyama M, et al. Surgery for pulmonary metastases from colorectal cancer: the importance of prethoracotomy serum carcinoembryonic antigen as an indicator of prognosis. Jpn J Thorac Cardiovasc Surg. 2003;51(7):289–96.

    Article  PubMed  Google Scholar 

  21. Lee WS, Yun SH, Chun HK, Lee WY, Yun HR, Kim J, et al. Pulmonary resection for metastases from colorectal cancer: prognostic factors and survival. Int J Colorectal Dis. 2007;22(6):699–704.

    Article  PubMed  Google Scholar 

  22. Rena O, Casadio C, Viano F, Cristofori R, Ruffini E, Filosso PL, et al. Pulmonary resection for metastases from colorectal cancer: factors influencing prognosis. Twenty-year experience. Eur J Cardiothorac Surg. 2002;21(5):906–12.

    Article  PubMed  Google Scholar 

  23. Saito Y, Omiya H, Kohno K, Kobayashi T, Itoi K, Teramachi M, et al. Pulmonary metastasectomy for 165 patients with colorectal carcinoma: A prognostic assessment. J Thorac Cardiovasc Surg. 2002;124(5):1007–13.

    Article  PubMed  Google Scholar 

  24. Shiono S, Ishii G, Nagai K, Yoshida J, Nishimura M, Murata Y, et al. Histopathologic prognostic factors in resected colorectal lung metastases. Ann Thorac Surg. 2005;79(1):278–82; discussion 283.

    Article  PubMed  Google Scholar 

  25. Vogelsang H, Haas S, Hierholzer C, Berger U, Siewert JR, Prauer H. Factors influencing survival after resection of pulmonary metastases from colorectal cancer. Br J Surg. 2004;91(8):1066–71.

    Article  PubMed  CAS  Google Scholar 

  26. Headrick JR, Miller DL, Nagorney DM, Allen MS, Deschamps C, Trastek VF, et al. Surgical treatment of hepatic and pulmonary metastases from colon cancer. Ann Thorac Surg. 2001;71(3):975–9; discussion 979–80.

    Article  PubMed  CAS  Google Scholar 

  27. Iizasa T, Suzuki M, Yoshida S, Motohashi S, Yasufuku K, Iyoda A, et al. Prediction of prognosis and surgical indications for pulmonary metastasectomy from colorectal cancer. Ann Thorac Surg. 2006;82(1):254–60.

    Article  PubMed  Google Scholar 

  28. Kanemitsu Y, Kato T, Hirai T, Yasui K. Preoperative probability model for predicting overall survival after resection of pulmonary metastases from colorectal cancer. Br J Surg. 2004;91(1):112–20.

    Article  PubMed  CAS  Google Scholar 

  29. Watanabe I, Arai T, Ono M, Sugito M, Kawashima K, Ito M, et al. Prognostic factors in resection of pulmonary metastasis from colorectal cancer. Br J Surg. 2003;90(11):1436–40.

    Article  PubMed  CAS  Google Scholar 

  30. Melloni G, Doglioni C, Bandiera A, Carretta A, Ciriaco P, Arrigoni G, et al. Prognostic factors and analysis of microsatellite instability in resected pulmonary metastases from colorectal carcinoma. Ann Thorac Surg. 2006;81(6):2008–13.

    Article  PubMed  Google Scholar 

  31. Ike H, Shimada H, Ohki S, Togo S, Yamaguchi S, Ichikawa Y. Results of aggressive resection of lung metastases from colorectal carcinoma detected by intensive follow-up. Dis Colon Rectum. 2002;45(4):468–73; discussion 473–5.

    Article  PubMed  Google Scholar 

  32. Moore KH, McCaughan BC. Surgical resection for pulmonary metastases from colorectal cancer. ANZ J Surg. 2001;71(3):143–6.

    Article  PubMed  CAS  Google Scholar 

  33. Welter S, Jacobs J, Krbek T, Poettgen C, Stamatis G. Prognostic impact of lymph node involvement in pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg. 2007;31(2):167–72.

    Article  PubMed  Google Scholar 

  34. Miller G, Biernacki P, Kemeny NE, Gonen M, Downey R, Jarnagin WR, et al. Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases. J Am Coll Surg. 2007;205(2):231–8.

    Article  PubMed  Google Scholar 

  35. Shah SA, Greig PD, Gallinger S, Cattral MS, Dixon E, Kim RD, et al. Factors associated with early recurrence after resection for hepatocellular carcinoma and outcomes. J Am Coll Surg. 2006;202(2):275–83.

    Article  PubMed  Google Scholar 

  36. Carpizo DR, Are C, Jarnagin WR, DeMatteo RP, Fong Y, Gonen M, et al. Liver resection for metastatic colorectal cancer in patients with concurrent extrahepatic disease: results in 127 patients treated at a single center. Ann Surg Oncol. 2008; In Press.

  37. Koppe MJ, Boerman OC, Oyen WJ, Bleichrodt RP. Peritoneal carcinomatosis of colorectal origin: incidence and current treatment strategies. Ann Surg. 2006;243(2):212–22.

    Article  PubMed  Google Scholar 

  38. Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21(20):3737–43.

    Article  PubMed  Google Scholar 

  39. Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15(9):2426–32.

    Article  PubMed  Google Scholar 

  40. Elias D, Dube P, Bonvalot S, Meshaka P, Manai M, Cavalcanti A, et al. Treatment of liver metastases with moderate peritoneal carcinomatosis by hepatectomy and cytoreductive surgery followed by immediate post-operative intraperitoneal chemotherapy: feasibility and preliminary results. Hepatogastroenterology. 1999;46(25):360–3.

    PubMed  CAS  Google Scholar 

  41. Elias D, Benizri E, Pocard M, Ducreux M, Boige V, Lasser P. Treatment of synchronous peritoneal carcinomatosis and liver metastases from colorectal cancer. Eur J Surg Oncol. 2006;32(6):632–6.

    Article  PubMed  CAS  Google Scholar 

  42. Elias DD, Ouellet JJF, Bellon NN, Pignon JJP, Pocard MM, Lasser PP. Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg. 2003;90(5):567–74.

    Article  PubMed  CAS  Google Scholar 

  43. Adson MA. Resection of liver metastases–when is it worthwhile? World J Surg. 1987;11(4):511–20.

    Article  PubMed  CAS  Google Scholar 

  44. Elias DD, Sideris LL, Pocard MM, Ouellet JFJ-F, Boige VV, Lasser PP, et al. Results of R0 resection for colorectal liver metastases associated with extrahepatic disease. Ann Surg Oncol. 2004;11(3):274–80.

    Article  PubMed  Google Scholar 

  45. Elias DD, Liberale GG, Vernerey DD, Pocard MM, Ducreux MM, Boige VV, et al. Hepatic and extrahepatic colorectal metastases: when resectable, their localization does not matter, but their total number has a prognostic effect. Ann Surg Oncol. 2005;12(11):900–9.

    Article  PubMed  Google Scholar 

  46. Strasberg SS. Re: Hepatic and extrahepatic colorectal metastases: when resectable, their localization does not matter, but their total number has a prognostic effect. Ann Surg Oncol. 2007;14(4):1517–8.

    Article  PubMed  Google Scholar 

  47. Fortner JG, Silva JS, Golbey RB, Cox EB, Maclean BJ. Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. I. Treatment by hepatic resection. Ann Surg. 1984;199(3):306–16.

    Article  PubMed  CAS  Google Scholar 

  48. Kobayashi K, Kawamura M, Ishihara T. Surgical treatment for both pulmonary and hepatic metastases from colorectal cancer. J Thorac Cardiovasc Surg. 1999; 118(6):1090–6.

    Google Scholar 

  49. Nagakura S, Shirai Y, Yamato Y, Yokoyama N, Suda T, Hatakeyama K. Simultaneous detection of colorectal carcinoma liver and lung metastases does not warrant resection. J Am Coll Surg. 2001;193(2):153–60.

    Google Scholar 

  50. Reddy RH, Kumar B, Shah R, Mirsadraee S, Papagiannopoulos K, Lodge P, et al. Staged pulmonary and hepatic metastasectomy in colorectal cancer--is it worth it? Eur J Cardiothorac Surg. 2004;25(2):151–4.

    Google Scholar 

  51. Mineo TC, Ambrogi V, Tonini G, Bollero P, Roselli M, Mineo D, et al. Longterm results after resection of simultaneous and sequential lung and liver metastases from colorectal carcinoma. J Am Coll Surg. 2003;197(3):386–91.

    Google Scholar 

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Acknowledgment

We would like to acknowledge Tina M. Thomas for her assistance in preparation of this manuscript.

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Authors and Affiliations

  1. Division of Surgical Oncology, The Cancer Institute of New Jersey, Robert Wood-Johnson University Medical School, New Brunswick, NJ, USA

    Darren R. Carpizo MD, PhD

  2. Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Michael D’Angelica MD

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  1. Darren R. Carpizo MD, PhD
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  2. Michael D’Angelica MD
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Correspondence to Michael D’Angelica MD.

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Carpizo, D.R., D’Angelica, M. Liver Resection for Metastatic Colorectal Cancer in the Presence of Extrahepatic Disease. Ann Surg Oncol 16, 2411–2421 (2009). https://doi.org/10.1245/s10434-009-0493-6

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  • DOI: https://doi.org/10.1245/s10434-009-0493-6

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