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Should Hepatic Metastatic Colorectal Cancer Patients with Extrahepatic Disease Undergo Liver Resection/Ablation?

  • Hepatobiliary and Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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Abstract

Background

Surgical therapy has been proven to be the mainstay of treatment for hepatic metastases from colorectal cancer (CRM) in the appropriate patient. Previous contraindications were patients with extrahepatic disease (EHD) do not benefit from liver resection or ablation. We hypothesized that the survival of patients with EHD who receive aggressive multimodality care would be the same as those without EHD.

Methods

A review of our 1305 patient prospective hepato-pancreatico-biliary database from August 1995 to April 2008 identified 383 patients with surgical management of metastatic CRM to the liver.

Results

A total of 39 patients with limited EHD underwent liver resection/ablation vs 344 patients without EHD. There were no significant differences in hepatic disease burden (mean clinical risk score of 2.3 and 2.1 in patients with and without EHD, P = .19, and median number of hepatic metastases of 2 in each group, P = .88) or size of the largest lesion (mean 4.6 vs 4.5 cm with and without EHD, P = .84). EHD consisted of lung metastases in 33%, nodal metastases in 21%, peritoneal in 15%, unknown in 15%, and other in 15%. There was no difference in patients with and without EHD undergoing surgical with resection only in 41% vs 48%, ablation only in 31% vs 30%, and combined resection and ablation in 28% vs 22% (P = .61). Overall survival in patients with EHD was not significantly different (median survival 24 vs 33 months, P = .06).

Conclusions

A thorough understanding of the biology of disease and appropriate multimodality care can lead to improved survival in patients with EHD, when compared with chemotherapy alone.

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References

  1. Weitz J, Koch M, Debus J, Debus J, Hohler T, Galle PR, et al. Colorectal cancer. Lancet. 2005;365:153–65.

    Article  PubMed  Google Scholar 

  2. Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin. 2000;50:7–33.

    Article  CAS  PubMed  Google Scholar 

  3. Lewis AM, Martin RC. The treatment of hepatic metastases in colorectal carcinoma. Am Surg. 2006;72:466–73.

    PubMed  Google Scholar 

  4. Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, Assumpcao L, et al. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol. 2007;14:3481–91.

    Article  PubMed  Google Scholar 

  5. Vauthey JN, Choti MA, Helton WS. AHPBA/SSO/SSAT Consensus Conference on hepatic colorectal metastases: rationale and overview of the conference. January 25, 2006. Ann Surg Oncol. 2006;13:1259–60.

    Article  PubMed  Google Scholar 

  6. Elias D, Sideris L, Pocard M, Ouellet JF, Boige V, Lasser P, et al. Results of R0 resection for colorectal liver metastases associated with extrahepatic disease. Ann Surg Oncol. 2004;11:274–80.

    Article  PubMed  Google Scholar 

  7. Poston GJ, Figueras J, Giuliante F, Nuzzo G, Sobrero AF, Gigot JF, et al. Urgent need for a new staging system in advanced colorectal cancer. J Clin Oncol. 2008;26:4828–33.

    Article  PubMed  Google Scholar 

  8. Couinaud C. Le foie: Etudes anatomiques et Chirurgicales. Paris: Masson & Cie; 1957.

    Google Scholar 

  9. Martin RC, Scoggins CR, McMasters KM. Microwave hepatic ablation: initial experience of safety and efficacy. J Surg Oncol. 2007;96:481–6.

    Article  PubMed  Google Scholar 

  10. Reuter NP, Woodall CE, Scoggins CR, McMasters KM, Martin RC, et al. Radiofrequency ablation vs. resection for hepatic colorectal metastasis: therapeutically equivalent? J Gastrointest Surg. 2009;13:486–91.

    Article  PubMed  Google Scholar 

  11. Scoggins CR, Campbell ML, Landry CS, Slomiany BA, Woodall CE, McMasters KM, et al. Preoperative chemotherapy does not increase morbidity or mortality of hepatic resection for colorectal cancer metastases? Ann Surg Oncol. 2009;16:35–41.

    Article  PubMed  Google Scholar 

  12. 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;230:309–18.

    Article  CAS  PubMed  Google Scholar 

  13. Shah SA, Haddad R, Al Sukhni W, Kim RD, Greig PD, Grant DR, et al. Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma. J Am Coll Surg. 2006;202:468–75.

    Article  PubMed  Google Scholar 

  14. 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;197:386–91.

    Article  PubMed  Google Scholar 

  15. Adam R, de Haas RJ, Wicherts DA, et al. Is hepatic resection justified after chemotherapy in patients with colorectal liver metastases and lymph node involvement? J Clin Oncol. 2008;26:3672–80.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA

    Jerome Byam MD, Nathaniel P. Reuter MD, Charles E. Woodall MD, Charles R. Scoggins MD, Kelly M. McMasters MD, PhD & Robert C. G. Martin MD, PhD

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  1. Jerome Byam MD
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  2. Nathaniel P. Reuter MD
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  3. Charles E. Woodall MD
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  4. Charles R. Scoggins MD
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  5. Kelly M. McMasters MD, PhD
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  6. Robert C. G. Martin MD, PhD
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Corresponding author

Correspondence to Robert C. G. Martin MD, PhD.

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Byam, J., Reuter, N.P., Woodall, C.E. et al. Should Hepatic Metastatic Colorectal Cancer Patients with Extrahepatic Disease Undergo Liver Resection/Ablation?. Ann Surg Oncol 16, 3064–3069 (2009). https://doi.org/10.1245/s10434-009-0693-0

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  • DOI: https://doi.org/10.1245/s10434-009-0693-0

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