Management Of Hepatic Colorectal Metastases Research Articles

Laparoscopic Hepatectomy for Hepatic Colorectal Metastases – A Retrospective Comparative Cohort Analysis and Literature Review

BackgroundLaparoscopic hepatectomy (LH) for management of hepatic colorectal metastases (HCRM) is commonly being performed; however, there are limited reports comparing LH outcomes with those of open hepatectomy (OH) procedure. The aim of the present study was to compare perioperative outcomes between the LH and OH procedures performed at a single medical center.MethodsFrom Jan 2008 to May 2012, 30 patients with pathologically confirmed HCRM underwent LH, and 140 patients underwent OH at our hospital. Patients' demographics, perioperative outcomes were retrospectively analyzed.Results2 patients (6.7%) in the LH group underwent laparotomies for intraoperative hemorrhage. The LH group had an increased surgical duration (235 min vs. 365 min, (P<0.001), shorter hospital stay (7.5 days vs. 11.5 days, P<0.001), and fewer complications (26.2% vs. 55%, P<0.001) than the OH group. However, in a matched cohort comparison of 30 LH cases and 30 OH cases, no significant variations were observed in the following parameters: surgical duration (235 min vs. 255 min, P = 0.23), positive margin rates (6.7% vs. 0.0%, P = 0.27), or postoperative hematological changes. LH patients had less estimated blood loss (215 ml vs. 385 ml, P<0.001), less morbidity (26.2% vs. 50%, P = 0.02), shorter hospital stay (7.5 days vs. 11.5 days, P<0.001), and lower analgesic requests than with those in the OH group.ConclusionsLH for metastatic colorectal cancer is a safe and feasible treatment, even in patients who underwent prior laparotomy surgeries and provides significantly less morbidity and shorter hospital stay than OH, without compromising curability or increasing morbidity.

Optimizing resection for “responding” hepatic metastases after neoadjuvant chemotherapy

Fifty percent of patients with colorectal cancer will develop metastases at some time during their disease, with the liver being the most common site. Recent advances in the treatment of metastatic colorectal cancer have led to a change in treatment paradigm. What follows is a review of the surgical management of hepatic colorectal metastases responding to neoadjuvant chemotherapy. In addition, the complexity of treating patients with "disappearing" colorectal liver metastases is discussed.

Erratum to: Controversies in the Management of Hepatic Colorectal Metastases

The educational review series ‘‘Controversies in the Management of Hepatic Colorectal Metastases’’ published in the September 2009 issue of the Annals of Surgical Oncology was supported by educational grants from sanofiaventis U.S., Bristol-Myers Squibb, and ImClone Systems Inc. Following is the list of articles that comprise this Educational Series. Controversies in the Management of Hepatic Colorectal Metastases

Controversies in the Management of Hepatic Colorectal Metastases

Controversies in the Management of Hepatic Colorectal Metastases

Current management of colorectal hepatic metastasis

In the USA, cancers of the colon and rectum are the third most common site of new cancer cases and cancer deaths. With improved screening and adjuvant therapy, the survival of patients has increased substantially over the last decade. However, patients with metastatic disease often have limited survival. Hepatic metastasis is one of the most frequent sites of metastatic disease. In fact, 35–55% of patients with colorectal cancer will develop hepatic metastasis at some time during the course of their disease. Patients who are able to undergo complete resection of their hepatic metastases have the best chance of long-term survival. The goal of hepatic resection is to achieve complete resection of all metastases with microscopically negative surgical margins while preserving sufficient hepatic parenchyma. Survival following hepatic resection of colorectal metastasis now approaches 35–50%. However, approximately 65% of patients will have a recurrence at 5 years. Increasingly chemotherapeutic agents are being offered in the preoperative setting prior to operation. At the time of operation, patients with extensive hepatic disease can sometimes be offered ablative therapies combined with resection or staged approaches. Modern management of hepatic colorectal metastases necessitates a multidisciplinary approach to effectively treat these patients and increase the number of patients who will benefit from resection.

Major hepatic resection for colorectal liver metastases.

A 6 1/2 year experience in the management of hepatic colorectal metastases in a specialist unit is reviewed. During the period studied, 48 patients were referred of whom only 24 actually came to resection. There were two in-hospital deaths, at 20 and 60 days, and six patients had non-fatal complications. Although the extent of resection was greater than in most reported series (13 right hepatectomies and 6 extended right hepatectomies), the results of resection were broadly the same as those of others, with a median survival of 30 months and 2 and 3 year survivals of 50 and 44 per cent respectively. A number of factors which others have considered to be of prognostic significance were examined. Tumour clearance was the only important prognostic indicator, where a 5 mm clear margin between the tumour and cut surface produced a significant difference in survival. It is suggested that a much larger number of patients in the UK with hepatic colorectal metastases might be considered for resection.

Operative ultrasound establishes resectability of metastases by major hepatic resection.

In this study, the utility of intraoperative ultrasound in the surgical management of hepatic colorectal metastases requiring hepatic resection has been demonstrated. The intraoperative ultrasound technique has been described as a method to accurately monitor curative resection of large colorectal metastases requiring anatomical procedures such as right hepatic trisegmentectomy, bisegmentectomy, and hepatic lobectomy. Preoperative analysis of the patients reported utilizing either computed tomography, ultrasound, or magnetic resonance imaging demonstrated very well the extent of tumor but could not define a major anatomical resection along normal tissue planes. In the 3 patients demonstrated, intraoperative ultrasound was able to confirm a normal hepatic parenchymal dissection overlying the extensive tumors and enabled completion of the curative resections. Furthermore, we have described the intraoperative ultrasound criteria for assessment of resectability. These included a definition of the proximity of the major portal and hepatic venous structures, exclusion of simultaneous minimal metastatic disease in the remaining parenchyma, and the distinction between marginal resectability and resectability for cure along the proposed parenchymal dissection plane. We conclude that intraoperative ultrasound is important in the surgical management of metastatic colorectal cancer and can provide for a more complete clinical staging and appropriate selection of patients for curative major hepatic resection.