Resection Of Hepatic Metastases Research Articles

Role of ablation therapy in conjunction with surgical resection for neuroendocrine tumors involving the liver.

Resection of hepatic metastasis from neuroendocrine tumors (NETs) improves quality of life and prolongs 5-year survival. Ablation can be utilized with surgery to achieve complete resection. Although several studies report long-term outcomes for patients undergoing ablation, none have explored perioperative effects of ablation in patients with metastatic NETs. To determine if intra-operative ablation during hepatectomy increases risk of adverse outcomes such as surgical site infections (SSIs), bleeding, and bile leak. A retrospective analysis of the hepatectomy National Surgical Quality Improvement Program database from 2015-2019 was performed to determine the odds of SSIs, bile leaks, or bleeding in patients undergoing intraoperative ablation when compared to hepatectomy alone. Of the 966 patients included in the study, 298 (30.9%) underwent ablation during hepatectomy. There were 78 (11.7%) patients with SSIs in the hepatectomy alone group and 39 (13.1%) patients with a SSIs in the hepatectomy with ablation group. Bile leak occurred in 41 (6.2%) and 14 (4.8%) patients in the two groups, respectively; bleeding occurred in 117 (17.5%) and 33 (11.1%), respectively. After controlling for confounding variables, ablation did not increase risk of SSI (P = 0.63), bile leak (P = 0.34) or bleeding (P = 0.07) when compared to patients undergoing resection alone on multivariate analysis. Intraoperative ablation with hepatic resection for NETs is safe in the perioperative period without significant increased risk of infection, bleeding, or bile leak. Surgeons should utilize this modality when appropriate to achieve optimal disease control and outcomes.

The Role of the Multiparametric MRI LiverMultiScanTM in the Quantitative Assessment of the Liver and Its Predicted Clinical Applications in Patients Undergoing Major Hepatic Resection for Colorectal Liver Metastasis.

Liver biopsy remains the gold standard for the histological assessment of the liver. With clear disadvantages and the rise in the incidences of liver disease, the role of neoadjuvant chemotherapy in colorectal liver metastasis (CRLM) and an explosion of surgical management options available, non-invasive serological and imaging markers of liver histopathology have never been more pertinent in order to assess liver health and stratify patients considered for surgical intervention. Liver MRI is a leading modality in the assessment of hepatic malignancy. Recent technological advancements in multiparametric MRI software such as the LiverMultiScanTM offers an attractive non-invasive assay of anatomy and histopathology in the pre-operative setting, especially in the context of CRLM. This narrative review examines the evidence for the LiverMultiScanTM in the assessment of hepatic fibrosis, steatosis/steatohepatitis, and potential applications for chemotherapy-associated hepatic changes. We postulate its future role and the hurdles it must surpass in order to be implemented in the pre-operative management of patients undergoing hepatic resection for colorectal liver metastasis. Such a role likely extends to other hepatic malignancies planned for resection.

Percutaneous microcoil localization as an aid to ultrasound-guided hepatic gastrointestinal stromal tumor metastasis resection: A case report

Liver nodules that develop in children with cancer may represent primary malignancy, metastatic disease, or other conditions potentially requiring aggressive management. Laparoscopic methods have been utilized for nodule resection with perioperative ultrasonographic assistance. However, certain nodules in liver tissue can be difficult to identify on ultrasonography. Ultrasonography guided surgical resection after computer tomography (CT)-guided localization using microcoils is an innovative technique that has the potential to assist in the resection of small or deep liver nodules in children in these unique cases. A 15-year-old female presented with evidence of a hypermetabolic liver nodule on routine PET scan, 5 years following resection of a hepatic metastasis via right hepatic trisegmentectomy for primary gastrointestinal stromal tumor (GIST). Contrast-enhanced CT confirmed presence of a new suspicious liver nodule. Given the interval from initial treatment to the identification of this hepatic nodule, consent was received from patient and her family to surgically resect the nodule. However, pre-operatively the nodule could not be appreciated on ultrasonography. Interventional radiology was consulted for CT guided percutaneous microcoil localization of the hepatic nodule. CT-guided percutaneous microcoil localization with ultrasonographic guided liver resection allowed for complete resection of the liver nodule. We have successfully used an innovative technique of CT-guided microcoil placement to direct ultrasound-guided surgical resection of an otherwise ultrasound-occult liver nodule in the pediatric setting.

Conversion surgery for stage IV gastric cancer: a multicenter retrospective study

BackgroundRecent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC.MethodsA total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled. We retrospectively reviewed the clinicopathological data and prognosis.ResultsOf the 79 patients, 23 (31.1%) had initially resectable disease (IR) before chemotherapy, defined as positive for cancer on peritoneal cytology (CY1), resectable hepatic metastasis, or para-aortic lymph node No. 16a2/b1 metastasis. Of the 56 remaining patients with primary unresectable disease, 39 had peritoneal dissemination. R0 resection was accomplished in 63 patients (79.7%). The 3-year OS rates for patients with IR and unresectable disease were 78.3% and 44.5%, respectively. Multivariate analysis showed that IR (P = 0.014) and R0 (P = 0.014) were statistically significant independent prognostic factors for favorable OS. Among patients with peritoneal dissemination alone, OS was significantly better for patients with R0 resection than for patients with R1/2 resection, with the 3-year OS rates of 65.5% and 23.1%, respectively (P = 0.011).ConclusionsCS is a treatment option for selected patients with stage IV GC. Patients with IR and patients who achieve R0 resection may obtain a survival benefit from CS.

Hepatectomy is associated with improved oncologic outcomes in recurrent colorectal liver metastases: A propensity-matched analysis

BackgroundFollowing resection of colorectal liver metastasis, most patients have disease recurrence, most commonly intrahepatic. Although the role of resection in colorectal liver metastasis is well-established, there have been limited investigations assessing the benefit of repeat hepatic resection compared with systemic treatment alone for intrahepatic recurrence. MethodsA retrospective single-institution cohort study of patients with recurrent colorectal liver metastasis following curative-intent hepatectomy was performed from 2003 to 2019. The oncologic outcomes, including post-recurrence overall survival, were evaluated using Kaplan-Meier and Cox proportional hazards modeling. Patients undergoing repeat hepatic resection were propensity-matched with patients receiving systemic treatment alone based on relevant clinicopathologic variables. ResultsThere were 338 patients treated with hepatic resection for colorectal liver metastasis over the study period. Liver recurrence was observed in 147 (43%) patients at a median time of 10 months from prior resection, with a median post-recurrence overall survival of 29 months. There were 37 patients managed with repeat hepatic resection; 33 (89%) received perioperative chemotherapy. On propensity matching, there were no significant clinicopathologic differences between 37 patients having repeat hepatic resection and 37 patients treated with systemic treatment alone. Repeat hepatic resection was independently associated with improved 5-year post-recurrence overall survival compared with systemic treatment alone (median overall survival 41 vs 35 months, 5-year overall survival 19% vs 3%, P = .048). ConclusionDisease characteristics of patients with intrahepatic recurrence of colorectal liver metastasis, specifically the number of liver lesions and size of the largest lesion, are most predictive of survival and response to systemic therapy. Patients who recur with oligometastatic liver disease experience improved outcomes and derive benefit from curative-intent repeat hepatic resection with integrated perioperative systemic therapy.

Abstract 2109: Preoperative exercise therapy attenuates the progression of liver metastases following surgical stress by inducing Kupffer cells-mediated anti-tumor trained immunity

Abstract Introduction: Colorectal cancer (CRC) is a devastating disease, causing mortality worldwide, with the majority of the patients dying from hepatic metastasis. Resection of hepatic metastases improves overall disease-free survival. Unfortunately, not all patients have a successful surgical outcome. Pre-operative exercise therapy (PEx) have been demonstrated to be beneficial in the prevention of post-operative complications. Trained immunity in myeloid cells leads to an aggravated long-term inflammatory phenotype upon a secondary stimulation, a process that results from orchestrated metabolic-epigenetic changes. We hypothesize that PEx initially reverts pro-tumorigenic inflammatory responses following surgical stress and maintains an anti-tumor immune microenvironment through modulating Kupffer cells (KCs) with anti-tumor immunity. Methods: 8-week C57BL/6 mice were randomly divided into PEx and sedentary (Sed) groups, mice with PEx run on a motorized treadmill at a speed of 12.5 m/min for 60 min/day, 5 days/week for 4 weeks. 105 MC38 cells were injected directly through portal vein and surgical stress was subjected to a model of partial hepatic ischemia and reperfusion. The tumor progression was determined by bioluminescent imaging weekly. Both hepatic and tumor CD45+ cells from PEx or Sed mice 3 weeks after IR were submitted for single-cell RNA sequencing (scRNA-seq). Results: 4 weeks of PEx significantly reduces metastasis in the liver along 3 weeks after IR, compared with Sed controls. For the scRNA-seq, 11 cell lineages (KCs, monocytes, neutrophils, DCs, TAMs, TANs, B cells, CD4+ T cells, CD8+ T cells, NK cells, and NKT cells) were identified and annotated according to the transcriptomic profile of feature genes expression. Surprisingly, discontinued 4-week-PEx still led to a significant transcriptomic shift in the KCs. 3 clusters from the entire KCs population were unique in PEx mice. In contrast, 2 Clusters were derived from Sed mice. PEx-relevant KCs are enriched in gene expression related to the anti-tumor phenotype, whereas Sed-relevant KCs are enriched in gene expression related to pro-tumor or immunosuppressive phenotype, which suggests that PEx modulates transcriptomic changes in KCs towards an anti-tumor phenotype. Furthermore, with our established ex vivo trained immunity assay, we observe a clear induction of trained immunity in PEx-KCs when co-cultured with MC38 tumor cells, with noticeably higher levels of anti-tumor cytokines interferon (IFN)-γ and TNF-α compared to Sed-KCs. Summary: Our study is one of the first to show that PEx alters the hepatic immune microenvironment by shifting KC to a tumoricidal phenotype. This work offers a rationale for PEx for cancer patients undergoing liver surgery thereby decreasing post-operative metastases and morbidity. Citation Format: Hongji Zhang, Xiang Cheng, Chengli Shen, Meihong Deng, Allan Tsung, Hai Huang. Preoperative exercise therapy attenuates the progression of liver metastases following surgical stress by inducing Kupffer cells-mediated anti-tumor trained immunity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2109.

Retraction Note to: Radiofrequency ablation versus hepatic resection for breast cancer liver metastasis: a systematic review and meta-analysis.

The authors have retracted this article (Xiao et al., 2018). After publication, they became aware that a number of studies included in the meta-analysis did not meet the eligibility criteria and that errors were made in classification and statistical analysis. The conclusions presented are therefore unreliable. All authors agree with this retraction.

Oncologic efficacy of simultaneous hepatic resection for unexpected hepatic metastasis of the pancreatic cancer after neoadjuvant chemotherapy

Yun Beom RYU, Woohyung LEE*, Young Hoon ROH, Yoo Na LEE, Yong Jae KWON, Min Kyu SUNG, Dakyum SHIN, Sarang HONG, Bong Jun KWAK, Yejong PARK, Eunsung JUN, Ki Byung SONG, Jae Hoon LEE, Song Cheol KIM. Ann Hepatobiliary Pancreat Surg 2022;26:S82. https://doi.org/10.14701/ahbps.2022S1.OP-4-1

Analysis of Hepatic Artery Infusion (HAI) Chemotherapy Using Randomized Trials of Floxuridine (FUDR) for Colon Cancer Patients with Multiple Liver Metastases.

Colorectal cancer (CRC) is one of the leading causes of cancer-related death, with most of the people who have the disease developing numerous liver metastases. Sixty percent of colon cancer patients have liver metastases. Only 25% of those with resectable hepatic metastases are alive, and recurrence occurs in nearly half of these cases. Regardless of the fact that left-sided cancer has a higher rate of liver metastases, past study reveals that left- and right-sided liver metastatic colon cancer patients have different survival rates. Hepatic artery infusion (HAI) combined with systemic chemotherapy is a treatment option for patients with unresectable liver-only or liver-dominant colon liver metastases. Although HAI has only been performed in a few locations previously, this study used randomized trials of floxuridine (FUDR) to characterize patient selection and first perioperative results during the deployment of a new HAI program. In this research, we also looked at the technical aspects of placing implantable pumps and catheters for HAI chemotherapy, as well as the efficacy, morbidity, and outcomes of this therapy in colon cancer patients with numerous liver metastases. The parameters like toxicity, overall survival rate, response rate, and progression-free response for the suggested therapy are also analyzed. These findings have important implications for colon cancer adjuvant HAI chemotherapy.

Role of Ablation Therapy in Conjunction with Surgical Resection for Neuroendocrine Tumors (Nets): Risks and Benefits of Multimodality Surgical Treatment for Nets Involving Liver

Introduction: Resection of hepatic metastasis from neuroendocrine tumors (NETs) improves both quality of life and prolongs 5-year survival. Adjunct modalities such as intra-operative ablation are utilized in conjunction with surgery to achieve complete resection. The goal of this study is to determine if intra-operative ablation increases risk of adverse outcomes such as surgical site infections (SSIs), bleeding, and bile leak.

Efficacy of Upfront Hepatectomy without Neoadjuvant Chemotherapy for Resectable Colorectal Liver Metastasis

Introduction: Hepatectomy for resectalbe colorectal liver metastasis (CRLM) is recommended. However the efficacy of upfront hepatectomy without neoadjuvant chemotherapy (NAC) is unclear due to the uncertainty of perioperative systemic chemotherapy. It is also important to predict the prognosis when considering perioperative chemotherapy. This study evaluated the impact of neoadjuvant chemotherapy on the prognosis of patients with resectable colorectal liver metastasis and assessed the usefulness of Beppu’s nomogram for predicting prognosis. Methods: This retrospective study identified 88 consecutive inpatients who underwent primary hepatic resection for colorectal liver metastasis; 58 received neoadjuvant chemotherapy and 30 underwent upfront surgery. Factors associated with recurrence-free survival were identified via univariate and multivariate analysis. Propensity score analysis using inverse probability of treatment weighting (IPTW) was also performed. Results: On univariate analysis, poor recurrence-free survival was associated with multiple tumors, advanced primary tumor stage, vascular invasion by the primary tumor, a Beppu’s nomogram score ≥6, and neoadjuvant chemotherapy. On multivariate analysis, a Beppu’s nomogram score ≥6 and neoadjuvant chemotherapy were independent risk factors for recurrence. Neoadjuvant chemotherapy recipients had a higher incidence of lymph node metastasis and vascular invasion than non-recipients. Propensity score analysis revealed no significant difference in the recurrence-free survival rate between these groups. Conclusions: Our results show that upfront hepatectomy without neoadjuvant chemotherapy can be considered for resectable colorectal liver metastasis treatment. Beppu’s nomogram score can be an option as one of the tools for predicting the prognosis of patients with colorectal liver metastasis.

KRAS Mutation at Codon 12 Predicts Clinical Outcome in Repeat Hepatic Resection for Recurrent Colorectal Liver Metastases

Introduction: Repeat hepatic resection for recurrent colorectal liver metastasis (CRLM) has been shown to be associated with improved overall survival. Our aim was to elucidate the prognostic role of KRAS mutational status in predicting outcome in patients with CRLM undergoing repeat surgical resection after liver recurrence.

Disease-free remission of metastatic adrenocortical carcinoma following en bloc tumor resection and neoadjuvant chemotherapy for suspected adrenohepatic infiltration

A 3 year old boy with a family history of Li-fraumeni Syndrome presented with a right-sided adrenocortical carcinoma, hepatic, and pulmonary metastases. He underwent eight cycles of chemotherapy with Cisplatin, Etoposide, Doxorubicin and Mitotane. Follow-up CT Thorax/Abdomen/Pelvis with contrast demonstrated a reduction in size of the right suprarenal mass, decreased attenuation of liver metastases and one remaining pulmonary nodule. Discussion at multidisciplinary meeting ensued and open adrenalectomy and resection of hepatic metastases was recommended. Intra-operatively, gross appearance of adrenohepatic infiltration into the right hepatic lobe was identified and the decision was made to perform complete, en bloc resection of mass. The remaining pulmonary nodule resolved radiologically. The patient remains well and continues on maintenance adrenolytic therapy with mitotane. Thirteen months post-operatively, no locoregional disease recurrence has been identified on imaging. Disease-free remission is a rare occurrence in metastatic adrenocortical carcinoma. To the author's knowledge this is the first case report demonstrating the detailed surgical management of a child with an initial presentation of metastatic adrenocortical carcinoma.

Impact of Intraoperative Blood Loss and Blood Transfusion on the Prognosis of Colorectal Liver Metastasis Following Curative Resection.

The identification of risk factors for recurrence after resection of colorectal liver metastasis is necessary in order to establish a more effective treatment strategy. In addition to well-known prognostic factors, such as the tumor diameter and number of metastatic tumors, a large amount of intraoperative blood loss (IBL) and blood transfusion have recently been reported to be associated with shorter long-term survival. The aim of this study was to assess the impact of IBL and blood transfusion on the prognosis of colorectal liver metastasis after curative resection. A total of 104 patients who underwent R0 resection for colorectal liver metastasis were enrolled in this study. The high-IBL (>300 ml) group had significantly shorter relapse-free survival after hepatic resection in comparison to the low-IBL (≤300 ml) group (p=0.0025). Patients with blood transfusion had significantly shorter relapse-free survival after hepatic resection in comparison to patients without blood transfusion (p=0.0026). A large amount of IBL and blood transfusion may have a negative impact on long-term survival in patients who undergo hepatic resection for colorectal liver metastasis.

Feasibility of hepatic resection for liver metastasis of head-and-neck carcinoma or esophageal carcinoma: a multi-center experience.

Patients with liver metastasis of head-and-neck carcinoma and esophageal carcinoma are generally not treated with hepatic resection, but there are no established standard treatment methods. We report 11 cases of hepatic resection for liver metastasis of head-and-neck carcinoma or esophageal carcinoma performed at 5 Japanese institutions. The subjects of this retrospective analysis were 11 patients who underwent hepatic resection for metastatic liver tumors, originating from head-and-neck carcinoma in 5 and from esophageal cancer in 6, between January, 2010 and March, 2020 RESULTS: There were nine men and two women (median age, 64years; range 40-72years). The primary disease was esophageal carcinoma in six patients and pharyngeal carcinoma in five patients. All cancers were squamous cell carcinoma. The time from the initial treatment to the diagnosis of liver metastasis was 15.3months and the 1-year and 3-year overall survival rates after hepatic resection were 72% and 32%, respectively. The overall and disease-free survival rates after hepatic resection were significantly higher for patients who underwent hepatic resection more than 12months after the initial treatment than for those who underwent hepatic resection within 12months after the initial treatment (p = 0.0172 and p = 0.0120, respectively). Liver resection may prolong the survival of patients with liver metastases controlled for more than 12months after the initial treatment of head and neck or esophageal carcinoma.

Long term outcomes of hepatic surgery for breast cancer metastasis – single institution experience.

Background: Stage IV breast cancer confers a poor prognosis with median survivals of 18-24 months. Surgical resection of hepatic metastasis is not a consensual treatment given the lack of evidence of benefit. The majority of patients are not fit for surgery because of the physical condition and disseminated disease, so the patients proposed to surgery are limited. The authors pretend to evaluate the long-term outcome of patients with breast cancer liver metastases submitted to hepatic surgery in one single institution.

Survival Benefits and Margin of Liver Metastasectomy in Colorectal Liver Metastasis

Background: Association between resection margin of hepatic resection for colorectal liver metastasis and survival outcome remains controversial. While a margin of 10mm had been the traditional standard, several studies had been published in the past with conflicting results. Method: This is a retrospective review of 385 patients who underwent liver resection for colorectal liver metastasis in a single centre from 2000-2017. Survival data were correlated with demographics, liver resection margin, KRAS status, CEA levels and analysed for statistical significance using long-rank test and cox regression with multivariate analysis. Result: There is statistically significant association between the width of liver resection margin and both overall and disease free survival. Microscopic margin of greater than 10 mm is associated with significant benefit in both disease free (9.8 vs 15.8 months P=0.001) & overall survival (43.9 vs 58.9 months P= 0.012). Cutoff for free resection margin beyond 14mm did not correlate with significant difference in survival. The other factors associated with survival benefits was CEA less than 5 on admission (95%CI 0.53-0.92 p=0.01). Conclusion: Liver resection margin of greater than 1mm is an independent predictor of increased disease free survival. There is clinically and statistically significant improved survival if liver resection margin of greater than 10mm can be achieved.

Population-Based Nationwide Study on Concomitant Hepatic Resection and Thermal Ablation for Colorectal Liver Metastasis in the Netherlands

Introduction: Since combining hepatic resection and thermal ablation (HR+TA) appears to improve short-term postoperative outcomes in patients with colorectal liver metastasis (CRLM), this study assessed hospital variation and short-term postoperative outcomes after HR+TA in the Netherlands. Methods: All patients who underwent liver resection for CRLM in the Netherlands during 2014-2018 were included. Multivariable logistic regression was used to assess case-mix variables and hospital variation in relation to HR+TA. Short-term postoperative outcomes were compared after propensity score matching (PSM) for age, ASA score, Charlson Comorbidity Index, diameter of CRLM prior to treatment, number of CRLM, and history of liver resection. Postoperative complicated course (PCC) was defined as no major complication or death and discharge within 14 days. Results: In total 4639 patients were included of whom 3697 (80%) underwent HR and of whom 942 (20%) underwent HR+TA. Four or more CRLM and bilobar disease were positively associated with use of HR+TA. Decreasing diameter of CRLM was negatively associated with HR+TA. Unadjusted percentage of HR+TA per hospital ranged between 4% and 44%. After PSM, 734 patients were included in each group. Length of stay (LOS) (median 7 vs 6 days, p=0.01), postoperative complicated course (15% vs 11%, p=0.04) and 30-day mortality 2% vs. 1%, p=0.01) were significantly lower in the HR+TA group. Conclusions: Significant hospital variation in the use of HR+TA is observed in the Netherlands. Short-term postoperative outcomes were significantly better regarding HR+TA and therefore HR+TA should be considered in patients with CRLM.

One-stage resection of primary colorectal cancer and hepatic metastases using the Habib Device: analysis of 40 consecutive cases treated in a Unit of general surgery.

More than 50% of patients with colorectal cancer (CRC) present or develop hepatic metastases (HM). The intraoperative use of the Habib 4X® radio frequency probe device is safe in resetting HM and allows a one-stage resection of both CRC and HM with a similar mortality rate than a two-stage surgical treatment. After an exhaustive residential training at the reference center for hepato-biliary surgery of the Imperial College of London, we treated at our unit of general surgery 40 consecutive patients with CRC and HM with the one-stage resection, using the Habib 4X® intraoperative radiofrequency probe device to reset HM. None of the 40 patients died during the intra-operatory and post-operatory periods, none presented liver failures during the postoperative course nor complication related to the Habib's resection procedure (e.g. bleeding, abscess, bile leak). The amount of intra-operative liver bleeding was minimal. New HM arose in 10 (25%) cases, with a mean disease-free interval of 13 months, but the hepatic tissue close to previous resections remained cancer-free. The 69.7% of patients were disease-free at month 24 of the post-operative follow-up and 5-year rate was about 70%. The data suggest that surgeons well trained at a reference center for hepato-biliary surgery may perform with excellent results the one-stage CRC and HM resection with the Habib 4X® device even in a Unit of general surgery.

Are hepatic and pancreatic resections justified for metastases from thyroid cancer: Outcomes from a systematic review of the literature

Background: The most common sites for distant metastases from thyroid carcinomas include the lung, followed by the bones, the brain, the liver and even more rarely the pancreas. The objective of our systematic review was to evaluate the long-term outcomes of surgical resection as a treatment strategy for liver (TCLM) and pancreatic metastases (TCPM) from thyroid cancer (TC). Materials and Methods: A systematic search of 3 electronic databases for articles published up to October 2018 was conducted. All appropriate observational studies and case reports which reported outcomes from patients with TC metastatic to the liver or pancreas were considered eligible for inclusion in the present systematic review. Results: A total of 15 studies, which comprised of 16 patients that underwent hepatic or pancreatic resection for TC metastasis, were included in the present systematic review; among them, 5 presented with metastasis to the liver, whereas 11 had pancreatic metastatic disease. The median time interval between the initial thyroidectomy and the diagnosis of metastases (either hepatic or pancreatic) was 60 months (SE: 23.8, 95% CI: 13.3-106.7) for the entire cohort and the mean overall survival was 37.6 months (SE: 8, 95% CI: 22-53.3). Five patients with pancreatic metastases presented with recurrence whereas no recurrences were noted in patients with liver metastases. Conclusions: Surgical resection of liver and pancreatic metastases from TC seems to be a safe and efficient treatment option for selected patients. In that setting, long term outcomes in patients with resected TCLM are encouraging given the absence of recurrence as reported from the included studies whereas in the case of TCPM, survival is limited due to advanced disease at diagnosis and recurrence rates.