Recurrent Colorectal Metastases Research Articles

Laparoscopic Sg 2 partial resection due to recurrent colorectal metastasis after open right hepatectomy: Video case report

Liver resection in combination with modern chemotherapy is effective way to treat colorectal liver metastases. Based on randomized trials results laparoscopic liver resection has benefits compared with open in terms of mortality and morbidity levels. Repeated liver resections are more complex procedures, but they also may be performed in laparoscopic way. We present case of 48-year-old female patient with 6-year history of sigmoid cancer. The patient had left colectomy followed by 6 FOLFOX courses. Four years after she presented with liver metastases in right liver and open right hepatectomy was made. After 2 years of uneventful follow-up, she was referred to our hospital with signs of metastatic tumor located in Sg 2 of liver remnant. Percutaneous thermal ablation was thought to be contraindicated due to close relation of tumor to diaphragm and pericardium and after discussion on MDT partial laparoscopic liver resection of Sg 2 was performed. The procedure last for 186 minutes, mostly because of precise viscerolysis. Left hemyliver was carefully detached from dense adhesions with adjacent organs. The Pringle maneuver was not used and estimated blood loss was 120 mL. Postoperative period was uneventful, patient was discharged on postoperative day 4. R0-resection margin was confirmed by pathologists. No tumor recurrence was observed on 1-year follow-up. Laparoscopic approach is accessible option for parenchyma sparing resections of colorectal liver metastasis even after previous open live surgery.

Robotic Repeat Right Hepatectomy for Recurrent Colorectal Liver Metastasis

Repeat hepatectomy often is required for primary and metastatic tumors. The purpose of this video was to present a robotic repeat hepatectomy for recurrent colorectal metastasis after multiple previous open surgeries. A 64-year-old man underwent open left colectomy complicated by anastomotic leak. He was reoperated for colostomy, which was reverted. One year later, he underwent open metastasectomy. Recently, he presented a recurrence in the right liver, and a robotic right hepatectomy was indicated. This approach used five trocars. The operation began with adhesiolysis. The next step was to dissect and divide the right hepatic artery and the right portal vein. A retrohepatic tunnel is created on the right side of the inferior vena cava for a modified liver hanging maneuver. The liver was pulled upwards and liver transection resumed towards the right hepatic vein. The liver was divided with bipolar forceps under continuous saline irrigation. The right hepatic duct was found inside the liver and was divided. Finally, the right hepatic vein was divided inside the liver parenchyma using a vascular stapler, and robotic right hepatectomy was completed. The operative time for docking was 10min; adhesiolysis took 90min while robotic right hepatectomy was completed in 240min. The Pringle maneuver was not used. Estimated blood loss was 150mL with no need for transfusion. Recovery was uneventful, and the patient was discharged on the fifth postoperative day. Robotic repeat hepatectomy is feasible and safe in experienced hands and may have some advantages over laparoscopic and open repeat liver resections.

Impact of RAS mutation on the long-term outcomes after repeat hepatectomy for recurrent colorectal metastasis

Impact of RAS mutation on the long-term outcomes after repeat hepatectomy for recurrent colorectal metastasis

Multidisciplinary approach to patients with recurrent colorectal liver metastases.

426 Background: Recurrence after liver resection (LR) for colorectal metastases (CLM) is common. Re-resection is the standard treatment. In unresectable patients, radiofrequency ablation (RFA) and stereotactic body radiation therapy (SBRT) have been proposed, but they did not show a clear survival benefit in comparison with chemotherapy alone. The present study aims to elucidate the outcome of patients with recurrent CLM according to the received treatment. Methods: A series of 323 consecutive patients undergoing first LR between 2004 and 2013 was considered. Of these, 206 (63.8%) had recurrence and were analyzed. Redo surgery was scheduled whenever possible. If surgery was excluded, RFA was considered for hepatic lesions, while SBRT for both hepatic and extra-hepatic lesions. Results: Among the 206 analyzed patients with recurrence, 72 underwent re-resection, 19 RFA and 14 SBRT. Liver-only recurrences were treated in 68.3% of cases (69/101, 47 surgery), pulmonary ones in 57.9% (22/38, 15 surgery) and other extra-hepatic ones in 20.9% (14/67, 10 surgery). After a median follow-up of 32 months, three-year survival after the diagnosis of recurrence (OS) was 42.2% (median 37.4 months). OS was associated with the administered treatment: at three years 70.5% if surgery, 53.8% if RFA/SBRT, and 15.0% if chemotherapy alone, p < 0.0001. The same association was observed focusing the analysis on patients with a total of three lesions in the liver and/or the lung (1-3 liver/lung group, n = 86): three-year OS was 82.6% if surgery, 55.8% if RFA/SBRT, and 29.2% if chemotherapy, p < 0.0001. Progression-free survival after the treatment of recurrence (PFS) was associated with the received treatment: at two years 29.0% if surgery, 14.4% if RFA/SBRT, and 2.6% if chemotherapy, p < 0.0001. The same result was observed in the “1-3 liver/lung” group: two-year PFS was 32.1% if surgery, 18.3% if RFA/SBRT, and 0% if chemotherapy, p = 0.001. RFA and SBRT groups had similar OS and PFS. Conclusions: Aggressive management of recurrent CLM prolongs OS and PFS. Surgery is the best treatment option. Despite potential selection biases, RFA and SBRT should be considered in unresectable patients because they are associated with better outcome than chemotherapy alone.

Safety and Efficacy of Ultrasound-Guided Radiofrequency Ablation of Recurrent Colorectal Cancer Liver Metastases after Hepatectomy

To assess the results and outcome of radiofrequency ablation in the treatment of recurrent colorectal liver metastases. Between January 2005 and September 2012, we treated 59 patients with recurrent colorectal metastases not amenable to surgery with 77 radiofrequency ablation procedures. Radiofrequency was indicated if oncologic resection was technically not possible or the patient was not fit for major surgery. A total of 91 lesions were treated. The mean number of liver tumors per patient was 1.5, and the mean tumor diameter was 2.3 cm. In 37.5% of the cases, lesions had a subcapsular location, and 34% were close to a vascular structure. The morbidity rate was 18.7%, and there were no post-procedural deaths. Distant extrahepatic recurrence appeared in 50% of the patients. Local recurrence at the site of ablation appeared in 18% of the lesions. Local recurrence rate was 6% in lesions less than 3 cm and 52% in lesions larger than 3 cm. The size of the lesions (more than 3 cm) was an independent risk factor for local recurrence (p < 0.05). Survival rates at 1, 3, and 5 years were 94.5%, 65.3%, and 21.7%, respectively. Radiofrequency ablation is a safe procedure and allows local tumor control in lesions less than 30 mm (local recurrence of 6%) and provides survival benefits in patients with recurrent colorectal liver metastases.

Surgical outcomes of second liver resections for recurrent hepatic metastases from colorectal cancer

To compare the clinical efficacies and safety of primary versus second liver resection for recurrent colorectal metastases to liver. Between January 2000 and March 2011, a total of 126 patients underwent liver resections for metastases from colorectal cancer at our institution. Among these, 16 patients underwent repeat liver resections. The comparisons were made for primary and second liver resections in blood loss volume, complications, hospital stay, operative duration and 1, 3, 5- year survival rates. Compared with primary liver resection group, the 1, 3, 5-year survival rates of second liver resection group were 93.8%, 56.1% and 37.4% respectively. For second hepatectomy group, blood loss volume was (323.8 ± 230.9) ml, operative duration (216.9 ± 79.7) min, postoperative hospital stay (23.4 ± 13.9) days and complication rate 18.8%. Compared with primary hepatectomy, there was no difference between two groups. Second liver resection may provide long-term survival rates similar to those of primary liver resections. Repeat liver resection is warranted when potentially curative.

Mo1736 Hepatic Metastasectomy Offers Improves Local Tumor Control Among Patients With Recurrent Colorectal Metastases

Mo1736 Hepatic Metastasectomy Offers Improves Local Tumor Control Among Patients With Recurrent Colorectal Metastases

P-0273 Hepatic Metastasis and Reccurence of Colorectal Cancer Assesment by 18FDG PET/CT

ABSTRACT Introduction Liver is the most frequent long distance metastasis site of digestive cancer. Early and accurate detection of hepatic metastasis as well as of tumoral recurrence is an important objective, especially in colorectal cancer, due to the improved 5 year surveillance rates after metastasectomy compared to nonsurgical therapy. Aim: to assess the use of 18FDG PET/CT (18 fluorodeoxyglucose positron emission tomography and computed tomography) in the detection of hepatic metastasis and recurrence of colorectal cancer. Methods Our study took place in the Emergency Clinical County Hospital (Oradea, Romania) in collaboration with PET POZITRON Diagnostic Center (Oradea, Romania). We studied 48 patients (38 men and 10 women, aged 48-74 years) who were previously treated by surgery for colorectal cancer. The FDG-PET/CT examination was made with the Siemens Biograph 16 unit (Germany) at 1 hour after the automatic infusion of FDG, at doses previously adjusted to individual parameters of each patient. Afterwards the recurrence and/or metastasis diagnosis was confirmed by colonoscopy, histology or other imaging techniques. At the same time, CEA (carcinoembryonic antigen) was measured. The statistical analysis was made with the help of SPSS application (Statistical Package for the Social Sciences). Results The time interval between the surgical intervention and PET/CT evaluation varied between 6 months to 8 years, with a mean value of 2.6 years. Out of the 48 studied patients recurrence and/or metastasis were diagnosed in 36 (75%) patients, including 8(16.7%) recurrences, 26 (54.2%) metastasis and 2 (4.1%) recurrence with metastasis. The diagnosis sensibility of identifying recurrent colorectal cancer and hepatic metastasis was 93% and its specificity was 84%. Treatment plans were changed in 8 (16.7%) patients after PET/CT evaluation. Localised metastasis were detected in the liver and lungs of 2 (4.2%) patients who were referred to surgery instead of chemotherapy. 4 patients (8.3%) had disseminated metastasis and were referred to chemotherapy. 2 (4.2%) patients with high levels of CEA and indication of iv chemotherapy in which conventional imaging showed no lesions, had at PET/CT evaluation, the following aspects: 1 patient had a recurrence and was resent to surgery and the other one, had lung and bone metastasis being thus referred to radio and chemotherapy. In our study group besides hepatic metastasis we also found metastasis in: lung (9/36, 25%), abdominal cavity and mesentery (8/36, 22%), retroperitoneal (7/36, 19%). Other secondary localizations included bone, lymph nodes, peritoneum and brain but the preferred metastasis foci were liver and lung. In some patients, beside conventional imaging examinations, PET/CT offered restaging of the disease. Conclusion 18FDG PET/CT examination can detect with high sensibility and specificity tumoral recurrences and/or hepatic metastasis. At the same time, in patients with surgically treated colorectal cancer it can identify lesions with abnormal metabolic levels, incipient occult metastasis and can orientate therapeutic measures.

Role of surgical resection in colorectal lung metastases: analysis of 137 patients

The aim of this study is to investigate clinicopathologic characteristics and to identify prognostic factors in patients undergoing pulmonary metastasectomy for colorectal carcinoma. This study is a single-institution retrospective study of 137 consecutive patients who underwent 158 pulmonary resections for metastatic colorectal carcinoma between January 1989 and June 2008. Median disease-free interval between colorectal resection and pulmonary metastasectomy was 35.6 months (range, 0.6 to 154.3 months). No perioperative deaths occurred. Follow-up was 100% complete and mean follow-up was 41.6 ± 27.6 months. Median survival was 36.2 months (range, 4.6 to 126 months). Overall 5- and 10-year survival rates were 55.4% and 30.8%, respectively, after pulmonary metastasectomy. At univariate analysis of patient survival, number of lung metastases (p = 0.002), disease-free interval of more than 24 month (p = 0.013), and absence of residual tumor (p = 0.024) were significant prognostic factors. At multivariate analysis, presence of solitary lung metastasis and disease-free interval of more than 24 months remained significant prognostic factors. There was no significant difference in the 5-year survival for 121 patients undergoing single thoracotomy compared with 16 patients undergoing repeated resection(s) for recurrent colorectal lung metastasis (55.1% vs 59.5%; p = 0.79). Nor was the presence of hepatic metastasis associated with lower outcome (p = 0.77). Disease-free interval and number of metastases are the most significant prognostic factors for survival after pulmonary metastasectomy for colorectal carcinoma. Recurrent pulmonary disease can benefit from repeated resection. Prior hepatectomy for liver involvement does not influence survival.

Repeated liver resection for recurrent liver cancer.

Patients with cancer recurrence limited to the liver alone after a first liver resection may be candidates for a repeat resection. Some 191 second and ten third liver resections for recurrent colorectal metastases, and 128 second and ten third liver resections for recurrent hepatocellular carcinoma (HCC), were evaluated after reviewing the literature. The 5-year survival rate after second liver resection for colorectal metastases was 26 per cent with a median survival time of 30 months. Mortality and morbidity rates were 1.2 and 27.4 per cent respectively. The 5-year survival rate after second resection for HCC was 40 per cent with a median survival time of 40 months. The operative mortality rate was 2.3 per cent; morbidity occurred in 13 per cent of patients with HCC. Survival after primary colorectal resection was significantly better for patients with metachronous metastases than for those with synchronous disease; survival correlated with a long interval between the first and second liver resection (in both colorectal liver cancer and HCC). Repeated liver resection may be performed in selected patients and yield a similar survival to that obtained after first liver resection.

Repeat Pulmonary Resection for Isolated Recurrent Lung Metastases Yields Results Comparable to Those after First Pulmonary Resection in Colorectal Cancer

Pulmonary resection for colorectal metastases is well accepted. However, the main cause of death after pulmonary resection is recurrence in the lung. The aim of this study was to clarify whether a repeat pulmonary resection was warranted in patients with recurrent lung metastases. The records of 76 patients undergoing initial pulmonary resection, including 14 patients undergoing a repeat operation for lung metastases, were reviewed for survival, operative morbidity, and mortality. Overall, pulmonary resection was performed 96 times in this group of patients. The operative mortality was 0%, morbidity involved only one case of major postoperative hemorrhage associated with the first operation. The cumulative 5-year survival rate for the 76 patients was 32%. After the second pulmonary operation, recurrence was identified in 79% (11 of 14) of the patients. In 10 patients with isolated lung recurrence after a first pulmonary resection, who showed no extrapulmonary disease before or at the time of first thoracotomy, the 3-year, and 5-year-survival rate after the second pulmonary resection was 67%, and 33%, respectively, comparing favorably with the survival rate in those who underwent primary pulmonary resection. In contrast, all 4 patients with extrapulmonary disease before or at the time of thoracotomy had poor prognosis. Repeat pulmonary operation for isolated recurrent colorectal metastases to the lung yielded results comparable to those after the first pulmonary resection in terms of operative mortality and survival in the absence of hilar/mediastinal lymph node or extrathoracic involvement.

Repeat hepatic surgery for colorectal cancer metastasis to the liver.

The authors addressed whether a repeat hepatic operation is warranted in patients with recurrent isolated hepatic metastases. Are the results as good after second operation as after first hepatic operation? Five-year survival after initial hepatic operation for colorectal metastases is approximately 33%. Because available alternative methods of treatment provide inferior results, hepatic resection for isolated colorectal metastasis currently is well accepted as the best treatment option. However, the main cause of death after liver resection for colorectal metastasis is tumor recurrence. Records of 95 patients undergoing initial hepatic operation and 10 patients undergoing repeat operation for isolated hepatic metastases were reviewed for operative morbidity and mortality, survival, disease-free survival, and pattern of failure. The literature on repeat hepatic resection for colorectal metastases was reviewed. The mean interval between the initial colon operation and first hepatic resection was 14 months. The mean interval between the first and second hepatic operation was 17 months. Operative mortality was 0%. At a mean follow-up of 33 +/- 27 months, survival in these ten patients was 100% at 1 year and 88% +/- 12% at 2 years. Disease-free survival at 1 and 3 years was 60% +/- 16% and 45% +/- 17%, respectively. After second hepatic operation, recurrence has been identified in 60% of patients at a mean of 24 +/- 30 months (median 9 months). Two of these ten patients had a third hepatic resection. Survival and disease-free survival for the 10 patients compared favorably with the 95 patients who underwent initial hepatic resection. Repeat hepatic operation for recurrent colorectal metastasis to the liver yields comparable results to first hepatic operations in terms of operative mortality and morbidity, survival, disease-free survival, and pattern of recurrence. This work helps to establish that repeat hepatic operation is the most successful form of treatment for isolated recurrent colorectal metastases.

Redo hepatic resection for metastatic colorectal carcinoma.

Redo hepatic resection for recurrent colorectal metastasis was performed in eight patients. There was no operative mortality; major morbidity occurred in 25% and minor morbidity in 13% of patients. Four patients are alive and disease-free at 9, 23, 39, and 49 months, respectively, after their repeat hepatic resection. Four patients have died of recurrent disease, with a median time to recurrence of 6 months and median survival of 15 months. Patterns of failure include hepatic failure alone in two patients and pulmonary and hepatic failure in two. Repeat liver resection can be performed safely and may be beneficial in some patients with recurrent metastases confined to the liver after previous hepatic metastasectomy.