Rectal Cancer Liver Metastases Research Articles

MRI T2WI-based radiomics combined with KRAS gene mutation constructed models for predicting liver metastasis in rectal cancer

BackgroundThe study aimed to identify the optimal model for predicting rectal cancer liver metastasis (RCLM). This involved constructing various prediction models to aid clinicians in early diagnosis and precise decision-making.MethodsA retrospective analysis was conducted on 193 patients diagnosed with rectal adenocarcinoma were randomly divided into training set (n = 136) and validation set (n = 57) at a ratio of 7:3. The predictive performance of three models was internally validated by 10-fold cross-validation in the training set. Delineation of the tumor region of interest (ROI) was performed, followed by the extraction of radiomics features from the ROI. The least absolute shrinkage and selection operator (LASSO) regression algorithm and multivariate Cox analysis were employed to reduce the dimensionality of radiomics features and identify significant features. Logistic regression was employed to construct three prediction models: clinical, radiomics, and combined models (radiomics + clinical). The predictive performance of each model was assessed and compared.ResultsKRAS mutation emerged as an independent predictor of liver metastasis, yielding an odds ratio (OR) of 8.296 (95%CI: 3.471–19.830; p < 0.001). 5 radiomics features will be used to construct radiomics model. The combined model was built by integrating radiomics model with clinical model. In both the training set (AUC:0.842, 95%CI: 0.778–0.907) and the validation set (AUC: 0.805; 95%CI: 0.692–0.918), the AUCs for the combined model surpassed those of the radiomics and clinical models.ConclusionsOur study reveals that KRAS mutation stands as an independent predictor of RCLM. The radiomics features based on MR play a crucial role in the evaluation of RCLM. The combined model exhibits superior performance in the prediction of liver metastasis.Clinical Trial NumberNot applicable.

A case of laparoscopic hepatic S4 partial resection after coronary artery bypass grafting using the right gastroepiploic artery

AbstractLaparoscopic liver resection has become safer over time, making it a viable option for patients previously considered high‐risk. We discuss a case in which a 73‐year‐old man underwent laparoscopic liver resection after coronary artery bypass grafting using the right gastroepiploic artery (RGEA). The patient was noted to have liver metastases of rectal cancer in the medial segment. Laparoscopic hepatic S4 partial resection was done after preoperative assessment of the RGEA graft pathway by computed tomography. During the operation, the RGEA graft was adherent to the dorsal surface of the liver, but the laparoscopic approach allowed fine dissection. The tumor was then safely removed, and the patient was discharged without complications. Preoperative assessment of the graft pathway is necessary because of the lack of tactile sensation during laparoscopic surgery. However, a magnified view of the laparoscope enabled us to perform fine dissection to avoid injury to the graft vessels.

Preoperative &lt;i&gt;Fusobacterium&lt;/i&gt; Septicemia Complicated by Liver Abscess in a Patient with Liver Metastasis of Rectal Cancer: A Case Report

Preoperative &lt;i&gt;Fusobacterium&lt;/i&gt; Septicemia Complicated by Liver Abscess in a Patient with Liver Metastasis of Rectal Cancer: A Case Report

Rescue percutaneous transhepatic portal vein embolization after failed associated liver partition and portal vein ligation for staged hepatectomy in a patient with multiple liver metastases of rectal cancer: a case report

BackgroundLiver metastasis is the most common form of distant spread of colorectal cancer. Despite oncological and surgical advances, only about 25% of patients are eligible to undergo resection. As the liver has a limited resectable volume, tumor reduction and remnant liver hypertrophy are of critical importance in treating initially unresectable colorectal cancer liver metastasis. Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows rapid liver hypertrophy within a short period and has been reported to be useful in recent years.Case presentationA 29-year-old woman complaining of bloody stool was referred to our hospital. She was diagnosed with rectal cancer (Rb) with simultaneous multiple liver and lung metastases. The patient was then initially commenced on chemotherapy and completed it with a satisfactory response. Right trisectionectomy was necessary to achieve hepatic clearance; however, the future liver remnant (FLR) volume was insufficient. Therefore, we decided to perform totally laparoscopic ALPPS to obtain enough FLR volume. However, the FLR increase was slow, and FLR did not attain the required volume for right trisectionectomy. Computed tomography showed that right portal venous blood flow was increased via developed collateral vessels around the portal vein. We attempted to induce further liver growth by blocking portal blood flow using additional percutaneous transhepatic portal vein embolization (PTPE), and a rapid increase in FLR was obtained. The patient underwent right trisectionectomy and partial resection of S2 with negative margins, and the patient was discharged without postoperative liver failure.ConclusionsResumption of the portal venous blood flow through collateral vessels after ALPPS may have interfered with the planned residual liver hypertrophy. Performing PTPE in addition to ALPPS increased the FLR volume, and radical hepatectomy was completed safely. Remnant portal venous blood flow following ALPPS is an important issue to be considered in surgical planning, and early additional portal vein embolization could be effective.

A safe and simple procedure for laparoscopic hepatectomy with combined diaphragmatic resection

Diaphragmatic resection may be required beneath the diaphragm in some patients with liver tumors. Laparoscopic diaphragmatic resection is technically difficult to secure in the surgical field and in suturing. We report a case of successful laparoscopic hepatectomy with diaphragmatic resection. A 48-year-old man who underwent laparoscopic partial hepatectomy for liver metastasis of rectal cancer 20 months ago underwent surgery because of a new hepatic lesion that invaded the diaphragm. The patient was placed in the left hemilateral decubitus position. The liver and diaphragm attachment areas were encircled using hanging tape. Liver resection preceded diaphragmatic resection with the hanging tape in place. Two snake retractors were used to secure the surgical field for the inflow of CO2 into the pleural space after diaphragmatic resection. The defective part of the diaphragm was repaired using continuous or interrupted sutures. Both ends of the suture were tied with an absorbable suture clip without ligation. In laparoscopic liver resection with diaphragmatic resection, the range of diaphragmatic resection can be minimized by performing liver resection using the hanging method before diaphragmatic resection. The surgical field can be secured using snake retractors. Suturing with an absorbable suture clip is conveniently feasible.

Synchronous robotic resection for colorectal liver metastasis

Surgical resection remains the only curative therapy for colorectal adenocarcinoma and liver metastasis. Synchronous robotic resection for colorectal liver metastasis (CRLM) offers the advantage of avoiding double surgical stress, while providing the benefits of small incision, quicker recovery, shorter hospital stay and faster postoperative adjuvant therapy. Compared with the laparoscopic approach, robotic approach is mostly suitable for rectal cancer liver metastasis, which is associated with low conversion rate, good nerve protection, high success rate for major hepatectomy and resection of difficult segments. Appropriately selected patients, multidisciplinary cooperation and skillful robotic surgeons are the key to success. Current data have demonstrated the feasibility and safety of synchronous robotic resection for CRLM. With the coming randomized controlled trial data and evolution of robotic surgical system, the future of synchronous robotic resection for colorectal liver metastasis is promising.

Primary tumour location is an important prognostic factor in colorectal cancer liver metastases following radiofrequency ablation

To examine the outcomes and different prognoses for colorectal cancer patients with liver metastases (CRCLM) treated with radiofrequency ablation (RFA) based on the origin of the primary tumour (rectum versus colon). Patients diagnosed with CRCLM from July 2011 to June 2018 were assessed in the study. The study included 114 patients with 176 lesions. All of the patients underwent RFA of their CRCLM. The overall survival (OS) and progression-free survival (PFS) were assessed with Kaplan-Meier survival function estimate curves and Cox regression analysis between the group of patients with rectal cancer liver metastases (RCLM) and colon cancer liver metastases (CCLM). Patients with RCLM exhibited worse OS and PFS than those with CCLM. The 1-, 2-, and 3-year OS rates were 87.5%, 75%, and 54.2% in the RCLM group and 93.9%, 87.8%, and 81.8% in the CCLM group (p=0.001), respectively. The 1-, 2-, and 3-year PFS rates were 43.7%, 22.9%, and 20.8% in the RCLM group and 57.6%, 45.4%, and 36.5% in the CCLM group (p=0.001), respectively. Multivariate analysis showed that primary tumour location, carcinoembryonic antigen (CEA), and response to pre-ablation chemotherapy were independent variables for OS and PFS. The N state of the primary tumour also had a significant impact on OS. This study showed that patients with CCLM had better prognoses than those with RCLM following RFA treatment. If patients intend to undergo RFA for CRCLM, the location of the primary tumour should be considered in the assessment of long-term therapeutic effects.

Cryopreserved biopsy tissues of rectal cancer liver metastasis for assessment of anticancer drug response invitro and invivo.

Living tumors are of great scientific value for clinical medicine and basic research, especially for drug testing. An increasing number of drug tests fail due to the use of imperfect models. The aim of the present study was to develop a novel method combining vitrification-based cryopreservation of tumor biopsies and precision-cut slice cultivation for the assessment of anticancer drug responses. Biological characteristics of rectal cancer liver metastasis biopsies could be retained by vitrification-based cryopreservation. The patient-derived xenograft models were successfully established using both fresh and warmed biopsy tissues. Precision-cut slicing provided a similar three-dimensional architecture and heterogeneity to the original tumor. The positive drug responses in the xenograft model were consistent with those in precision-cut slice cultures in vitro. The present study demonstrated that live tumor biopsies could be preserved using vitrification-based cryopreservation. The warmed tissues developed xenograft tumors, which were also useful for either in vivo or in vitro anticancer drug testing. Precision-cut slices derived from the warmed tissues provided an efficient tool to assess anticancer drug response in vitro.

Synchronous liver metastases of rectal cancer and the possibility of simultaneous resection

Treatment of metastatic rectal cancer and liver metastases continues to pose amajor challenge. Synchronous liver metastases are present in up to one fifth of patients diagnosed with rectal carcinoma. Multidisciplinary cooperation is essential for determination of the consequent diagnostic and therapeutic plan. Only tight collaboration of experts from different medical fields allows for optimal timing of various medical procedures leading to amaximal benefit for the patient. Given the complexity of the problem, different specific methods and combinations thereof are applied in the course of the therapy, making the design of straightforward guidelines impossible. Since open surgery is complicated by the vastly distant locations of the rectum and liver, minimally invasive approach brings more perspectives in simultaneous surgery. Anovel possibility of robotic and/or laparoscopic surgery performed by two teams is currently being developed. Despite the progress in surgical technology, optimal strategy has not yet been established.

4 cases of metastatic colorectal cancer treated by FOLFIRI+Aflibercept (FOLFIRI+AFL) after 3rd line

Abstract The efficacy of FOLFIRI+AFL therapy in the 2nd line for metastatic colorectal cancer was proved in VELOUR study. In Japan, Aflibercept (AFL) was permitted by health insurance medical treatment in 2017. But at that time, many patients had finished the strong chemotherapy or treated after 3rd line chemotherapy. So some patients hoped for the treatment of FOLFIRI+AFL. We study of 4 cases of metastatic colorectal cancer treated by FOLFIRI+AFL after 3rd line in our hospital. Case 1 38 y.o male contracted multiple lung and liver metastases of rectal cancer. He was treated by the following chemotherapies [CAPOX+BEV, FOLFIRI+BEV, FOLFOX+BEV, FTD/TPI] and ALF was introduced in 5th line. 14 courses of FOLFIRI+AFL were performed and the tumors temporarily reduced. Case 2 72 y.o female contracted multiple lymphnode metastases and peritoneal dissemination of sigmoid colon cancer. She was treated by the following chemotherapies [FOLFOX+CET, FOLFIRI+BEV] and ALF was introduced in 3rd line. 3 courses of FOLFIRI+AFL were performed but the tumors were increased (PD). Case 3 67 y.o female contracted unresectable rectal cancer and multiple lymphnode metastases. She was treated by the following chemotherapies [CAPOX+BEV, FOLFIRI+RAM] and ALF was introduced in 3rd line. 1 course of FOLFIRI+AFL was performed, but she deteriorated into bad condition and this therapy was stopped. Case 4 64 y.o female contracted paraaortic lymphnode metastases of rectal cancer . He was treated by the following chemotherapies [FOLFOX+CET, FOLFIRI+BEV, FOLFIRI+PANI] and ALF was introduced in 4th line. 3 courses of FOLFIRI+AFL were performed but the tumors were increased (PD). Conclusion Only Case1 showed tumor regression. But the other 3 cases those were treated by FOLFIRI + molecularly targeted agents except AFL in previous line, showed no efficacy. It is suggested that only exchange of molecularly targeted agents to AFL in FOLFIRI therapy dose not show the enough antitumor effect in colorectal cancer.

Dual Regulatory Mechanisms of Expression and Mutation Involving Metabolism-Related Genes FDFT1 and UQCR5 during CLM

Colorectal cancer (CRC) is the third most common cancer worldwide, and liver metastasis presents a major cause of CRC-associated death. Extensive genomic analysis has provided valuable insight into the pathogenesis and progression of CRC; however, a comprehensive proteogenomic characterization of CRC liver metastasis (CLM) has yet to be reported. Here, we analyzed the proteomes of 44 paired normal colorectal tissues and CRC tissues with or without liver metastasis, as well as analyzed genomics of CRC characterized previously by The Cancer Genome Atlas (TCGA) to conduct integrated proteogenomic analyses. We identified a total of 2,170 significantly deregulated proteins associated with CLM, 14.88% of which were involved in metabolic pathways. The mutated peptide number was found to have potential prognosis value, and somatic variants revealed two metabolism-related genes UQCR5 and FDFT1 that frequently mutated only in the liver metastatic cohort and displayed dysregulated protein abundance with biological function and clinical significance in CLM. Proteogenomic characterization and integrative and comparative genomic analysis provides functional context and prognostic value to annotate genomic abnormalities and affords a new paradigm for understanding human colon and rectal cancer liver metastasis.

Laparoscopic Isolated Caudate Lobectomy for Rectal Cancer Liver Metastasis

Summary: Metastatic tumor in the caudate lobe is difficult to manage and laparoscopic caudate lobectomy is regarded as a difficult procedure because of the deep location of the caudate lobe and its proximity to great vessels. Isolated caudate lobectomy is still rare and technically challenging. Therefore, we present a Case of a female patient who underwent laparoscopic isolated caudate lobectomy for liver metastasis of rectal cancer. A 58-year-old female was visited due to change in stool caliber. On the colonoscopy, mid rectal cancer was found. Surveillance computed tomography and magnetic resonance imaging showed 2cm metastatic liver mass in caudate lobe. We performed laparoscopic isolated caudate lobectomy for liver metastasis and laparoscopic low anterior resection for rectal cancer cooperatively. The caudate lobe was freed from the IVC and venous ligament. The short hepatic veins and the portal branches to the caudate lobe were ligated with clips. The procedure was completed totally laparoscopic technique. The operative time was 125 minutes. The intraoperative blood loss was minimal and the patient was safely discharged on the seventh postoperative day without perioperative complication. Pathology analysis showed a 2.4 × 2.1 × 2.1 cm metastatic adenocarcinoma with tumor-free resection margin. CT scan at 3 months after the operation showed complete removal of the caudate lobe with no evidence of recurrence. Our experience lobectomy demonstrated that laparoscopic caudate lobectomy is safe and feasible in patients with malignancy in caudate lobe.

Simultaneous Resection for Synchronous Colorectal Liver Metastasis: the New Standard of Care?

BackgroundOptimal surgical management for patients with synchronous colorectal cancer liver metastasis is controversial. We provide an analysis of surgical utilization and outcomes for patients presenting with synchronous colon and rectal cancer liver metastasis between simultaneous and staged approaches. MethodsSPARCS database was used to follow patients undergoing surgery for colorectal cancer with liver metastases from 2005 to 2014. Using International Classification of Diseases, Ninth Revision codes, we identified patients undergoing staged and simultaneous resection. Our primary endpoint was major events at 30-day follow-up. ResultsOf the patients, 1430 underwent surgery for synchronous colorectal primary and liver metastases between 2005 and 2014. There was no difference in adjusted rates of major events or anastomotic leak. Patients undergoing simultaneous resection were significantly less likely to experience prolonged length of stay (OR = 0.28; 95% CI = 0.21–0.37) or high hospital charges (OR = 0.24; 95% CI = 0.17–0.32) compared to staged resection even among patients undergoing total hepatic lobectomy and complex colorectal resection. ConclusionsSimultaneous resection was found to be equally as safe as staged resection even when evaluating patients undergoing more complex operations, and led to lower health care utilization. Under appropriate clinical circumstances, simultaneous resection offers benefits to patients and the health care system and should be the recommended surgical approach.

Two-stage hepatectomy and associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) in treating liver metastases of rectal cancer: a case report

IntroductionAn innovative approach, called associated liver partition and portal vein ligation for staged hepatectomy(ALPPS), has made possible a marked increase in future liver remnant (FLR) volume over a short period of time, thus permitting extended hepatectomy.Case descriptionThis report describes ALPPS in a 63-year-old male patient with rectal cancer and synchronous multiple liver metastases. The primary lesion was resected, followed by chemotherapy. We had planned to completely resect the metastases in both liver lobes, but CT volumetry revealed a very small FLR (364 ml, 29% of the total liver volume, 0.61% of total body weight). His indocyanine green retention rate at 15 minutes was 12.7%. Because of the risk of tumor progression in the interim, we performed ALPPS. During the first stage, the tumor in segment 3 was resected, the right lobe was mobilized, the liver was partitioned, and the right portal vein was ligated. The right hepatic artery, duct and vein were secured with vessel loops. CT on postoperative day 6 showed sufficient FLR increase (from 364 ml to 573 ml, or from 0.61% to 0.96% of total body weight) and ICGR15 improvement to 3.4%. The second stage of ALPPS was on postoperative day 7, completing resection of the metastases. The patient recovered well and was discharged 21 days after the second step.Discussion and evaluationThe ALPPS approach has many advantages, but it lacks evidence of long-term results. Considering the high mortality and morbidity rates of ALPPS, it is essential to evaluate its risks and benefits in individual patients and determine the strict criteria for this surgical method.ConclusionsALPPS procedure rapidly increases FLR, permitting extended hepatectomy for patients with initially insufficient FLR.

Individulized treatment of synchronous colorectal liver metastases

Liver metastasis is one of the critical prognostic factors for colorectal cancer.Complete surgical resection of liver metastases still remains the only potentially curative treatment for patients with liver metastases.There are still some controversies in how to choose the reasonable management for resectable colorectal cancer patients with simultaneous liver metastases,although neoadjuvant chemotherapy,tumor physical ablation technique and minimally invasive technology have made progress in recent years.One case of surgical treatment of synchronous rectal cancer liver metastasis at the Shengjing Hospital with laparoscopic microwave ablation + radical resection of colorectal cancer was disused in order to provide reference for individualized treatment for patients with the same disease. Key words: Rectal neoplasms ; Liver metastases ; Laparoscopy ; Microwave ablation ; Neoadjuvant chemotherapy

膿瘍化し十二指腸と瘻孔を形成した直腸癌同時性肝転移の1例

膿瘍化し十二指腸と瘻孔を形成した直腸癌同時性肝転移の1例

胆管浸潤を認め肝内胆管癌との鑑別を要した直腸癌肝転移の1例

胆管浸潤を認め肝内胆管癌との鑑別を要した直腸癌肝転移の1例

Primary hepatic leiomyosarcoma with liver metastasis of rectal cancer

Primary hepatic leiomyosarcoma is a particularly rare tumor with a poor prognosis. Curative resection is currently the only effective treatment, and the efficacy of chemotherapy is unclear. This represents the first case report of a patient with primary hepatic leiomyosarcoma co-existing with metastatic liver carcinoma. We present a 59-year-old man who was diagnosed preoperatively with rectal cancer with multiple liver metastases. He underwent a curative hepatectomy after a series of chemotherapy regimens with modified FOLFOX6 consisting of 5-fluorouracil, leucovorin and oxaliplatin plus bevacizumab, FOLFIRI consisting of 5-fluorouracil, leucovorin and irinotecan plus bevacizumab, and irinotecan plus cetuximab. One of the liver tumors showed a different response to chemotherapy and was diagnosed as a leiomyosarcoma following histopathological examination. This case suggests that irinotecan has the potential to inhibit the growth of hepatic leiomyosarcomas. The possibility of comorbid different histological types of tumors should be suspected when considering the treatment of multiple liver tumors.

ＴＡＥが効果を示し２期的に切除しえた直腸癌同時性多発性肝転移の１例

ＴＡＥが効果を示し２期的に切除しえた直腸癌同時性多発性肝転移の１例