Surgical Treatment Of Liver Metastases Research Articles

Surgical treatment of liver metastases from colorectal cancer in elderly patients

The liver is the most frequent site of liver metastases (LM) from colorectal cancer. Because of short life expectancies and improved nonoperative modalities, the role of liver resection in elderly patients with LM is unclear. During a 15-year period, 197 patients underwent liver resection for colorectal metastases. This study was designed to compare morbidity, mortality, and long-term outcome after hepatic resection in patients aged 70 years and older and in patients younger than 70. According to the age at the time of operation, patients were divided into two groups. Group A included patients aged 70 years or older and group B included younger patients. The clinical and pathologic parameters of the two groups were compared and tested as factors affecting early and long-term outcomes after resection. A modified oncologic clinical risk score (CRS) was tested on this series of patients. Overall morbidity was 16.3% (group A 20.7% vs group B 14.6%; P=0.18). Hospital mortality was 3% (5.7% in group A and 2.1% in group B; P=0.19). Actuarial 5 years survival were 30% in group A and 38% in group B (P=ns). The presence of more than three Fong's CRS parameters and microscopic involvement of resectional margin directly affected survival. Under meticulous preoperative assessment and postoperative care, liver resection for LM is justified in patients over 70 years of age; age by itself may not be a controindication to surgery.

Ileal Carcinoid with Liver Metastasis Presenting after Ten Years with Abdominal Mass and Right Heart Failure: Report of a Case

A case of ileal carcinoid metastatic to the liver is reported. The diagnosis was made and treatment given ten years after the detection of a left hypervascular liver mass, which was first confounded with a hemangioma. The onset of right heart failure led to surgical replacement of the tricuspid and pulmonary valves. After cardiac surgery the patient underwent an ileal resection and left hepatectomy for a cystic left liver metastasis. Isolated right heart failure and cystic degeneration of a liver metastasis are uncommon features of metastatic carcinoid tumors; only a few cases have been described in the literature. Cardiac surgery is recommended before liver surgery to reduce venous pressure and consequent bleeding during hepatectomy. Surgical treatment of liver metastases may relieve endocrine symptoms and result in an overall five-year survival rate of 47%.

Surgical Therapy for Metastatic Disease to the Liver

The liver is a common site of hematogenous metastasis. In the past, patients with liver metastases were often deemed inoperable, and medical therapy conferred only minor survival benefit. However, advances in surgical techniques and chemotherapeutic agents during the past two decades have led to effective treatments for selected patients with metastases to the liver. Up to approximately 80% of the liver can be resected, and partial hepatectomy is now routinely performed with a perioperative mortality rate of <5%. Surgical resection of colorectal cancer metastatic to the liver results in a 5-year survival rate of 40%. These results are expected to improve even further with multimodality approaches that include newer chemotherapy regimens. Liver metastases from other primary tumors, such as neuroendocrine carcinoma and genitourinary tumors, are also treated effectively with liver resection. The indications for surgical treatment of liver metastases are broadening as a variety of novel therapies are being developed, including hepatic artery embolization, hepatic artery infusion of chemotherapy, and radiofrequency ablation.

Surgical treatment of liver metastases by radiofrequency ablation, resection, or in combination

Aims. Radiofrequency ablation (RFA) has a role in the treatment of unresectable liver metastases either percutaneously or in open surgery. The aim of this study was to determine the feasibility and value using RFA, resection or in combination to cure liver metastases of colorectal or other origin. Methods. Fifty-two consecutive patients were operated on with the intention to treat their liver metastases using both techniques of RFA and resection in the same curative intent. A CT scan was performed 2 months postoperatively and then every 4 months. Results. Fifty patients with 137 metastases could be treated: 55 lesions were resected and 82 were ablated. Curative treatment of 13 patients could only be achieved by using RFA combined with resection. Morbidity was 16% and local treatment proved insufficient in three cases. Estimated 1-year survival probabilities were, respectively, 0.85 in the colorectal group and 0.80 in the non-colorectal group. Conclusions. RFA increased resectability of liver metastases and reduced the morbidity. Respective indications of both techniques were complementary and depend on the size and the topography of the lesion to be treated.

The current status of surgical treatment of liver metastases

The current status of surgical treatment of liver metastases

3 OC Surgical treatment of liver metastases of colorectal cancer: A multimodal approach

3 OC Surgical treatment of liver metastases of colorectal cancer: A multimodal approach

Surgical treatment of liver metastases

Approximately 50% to 60% of patients with colorectal cancer will develop hepatic metastases during the course of their illness, with 20% to 30% of patients having liver metastases at time of diagnosis. In nearly a quarter of these patients the liver is the only site of disease. Surgical resection of isolated hepatic metastases has been associated with a 27% to 37% 5-year survival and confers a survival advantage compared to patients not undergoing resection. Thorough preoperative and intraoperative evaluation is necessary to select appropriate surgical candidates who may benefit from resection. This article examines criteria useful in patient selection, and also reviews the management of recurrent hepatic metastases and the role of repeat hepatic resection. Semin Oncol 29:107-118. Copyright 2002, Elsevier Science (USA). All rights reserved.

Minimal liver resection strongly stimulates the growth of human colon cancer in the liver of nude mice.

Partial hepatectomy has been widely employed in clinical practice as the therapy of choice for primary and metastatic liver tumors. However, the recurrence rate after the treatment remains high, which is most likely due to the growth of residual microscopic lesions. Previous studies in murine models demonstrated that a 70% hepatectomy significantly accelerated the growth of ectopically implanted tumors. In this study, we reported the effect of partial hepatectomy on the growth of two human colon cancers (Co-3 and AC3603) implanted in the liver of nude mice using the technique of surgical implantation of histologically intact tumor tissue. Our results showed a dramatic acceleration of tumor growth following 30% partial hepatectomy, which resembles clinical procedures. Tumor volumes were assessed with calipers on day-15 by abdominal palpation and on day-30 at autopsy by direct measurement. For both Co-3 and AC3603, tumor volumes in the hepatectomized animals were significantly larger than the control at the above two time points (P < 0.001). The results demonstrate the stimulating effect of partial hepatectomy directly on the tumor growth in the liver, in contrast to previous studies on ectopic tumors. Furthermore, since conservative partial hepatectomy (30%) is normally used in clinical practice for surgical treatment of liver metastasis, the animal models presented here should be useful for the clinical investigation of the high recurrence rate of liver metastasis following partial hepatectomy.

Treatment of liver metastases in patients with neuroendocrine tumors.

Hepatic metastases of neuroendocrine tumors demand differentiated therapeutic management due to the unique natural course and hormone secretion of the tumors. The purpose of the prospective nonrandomized study was to review the institutional experience with surgical treatment of hepatic neuroendocrine metastases. From September 1992 until March 1996 29 consecutive patients with neuroendocrine tumors have been evaluated for surgical treatment of liver metastases. Of them, 11 (37.9%) fulfilled criteria for surgical treatment of hepatic secondary tumors. Extensive preoperative workup was carried out. Patients were divided in groups for curative or palliative resection. Liver transplantation was carried out in selected patients with disseminated liver metastases. Of 29 patients 4 (13.7%) underwent curative resection and in 3 patients (10.3%) palliative resection was performed. The patients who underwent curative resection are all biochemically and clinically tumor free at a mean postoperative follow-up of 22.3 months. Two patients who underwent palliative resection are alive at 40 and 29 months, respectively. From 12 patients evaluated for liver transplantation 4 were considered as suitable candidates. Liver resection can be recommended in patients with hepatic metastases of neuroendocrine tumors in terms of potential survival prolongation and palliation. Liver transplantation is generally acceptable treatment in highly selected group of these patients. Long-term results have to be awaited before definitive proof of the beneficial effect of surgical treatment.

Surgical resection of metastatic cancer to the liver

Surgical resection is the only treatment modality that provides the chance of cure for patients with metastatic spread to the liver. This report reviews the indication, technique and results of surgical resection of liver metastases. Most of the data on hepatic resection for metastatic disease relates to colorectal secondaries. Generally 5-year survival rates between 30 and 40% have been reported after surgical treatment of liver metastases originating from colorectal cancer. The operative mortality ranges between 0 and 5%. However these positive results are only obtained in patients with less than 4 metastases and without extrahepatic spread. Consequently careful preoperative staging is mandatory to identify patients who are likely to benefit of operative treatment. The criteria for the indication for liver resection of non-colorectal liver metastases have not yet been defined clearly. For such tumors the prognosis after liver resection is significantly poorer compared to patients with colorectal malignancy. Surgical resection of liver metastases from colorectal cancer can improve the prognosis in selected patients and even result in cure. In contrast liver resection in patients with non-colorectal primaries rarely results in improved prognosis.

Resection margins for colorectal metastases to the liver: do they make a difference?

Objective: The authors determined an appropriate surgical treatment for liver metastases from colorectal cancers. Clinicopathologic featuresof metastatic lesions of colorectal cancers were studied. Summary Background Data: Major hepatic resection is the usual procedure for treatment of hepatic metastases from colorectal cancers. Methods: Forty consecutive patients who underwent hepatic resections were prospectively studied, for a total of 89 metastatic liver tumors. Results: Metastatic tumor often extended along Glisson’s capsule, including invasion to the portal vein (9 cases), the hepatic vein (3 cases), the bile duct (16 cases), and the nerve (6 cases). The main tumor had small satellite nodules in only one patient, and there were no microscopic deposits in the parenchyma, even within 10 mm from the metastatic tumors. Fibrous pseudocapsule formation was observed in 28 patients. Discussion: The rarity of intrahepatic metastasis from metastatic tumor supports nonanatomic limited hepatic resection as the procedure of choice for metastatic colorectal cancer in the liver. The spread via Glisson's capsule should be taken into consideration for complete tumor clearance.

Pathologic Support for Limited Hepatectomy in the Treatment of Liver Metastases from Colorectal Cancer

The authors determined an appropriate surgical treatment for liver metastases from colorectal cancers. Clinicopathologic features of metastatic lesions of colorectal cancers were studied. Major hepatic resection is the usual procedure for treatment of hepatic metastases from colorectal cancers. Forty consecutive patients who underwent hepatic resections were prospectively studied, for a total of 89 metastatic liver tumors. Metastatic tumor often extended along Glisson's capsule, including invasion to the portal vein (9 cases), the hepatic vein (3 cases), the bile duct (16 cases), and the nerve (6 cases). The main tumor had small satellite nodules in only one patient, and there were no microscopic deposits in the parenchyma, even within 10 mm from the metastatic tumors. Fibrous pseudocapsule formation was observed in 28 patients. The rarity of intrahepatic metastasis from metastatic tumor supports nonanatomic limited hepatic resection as the procedure of choice for metastatic colorectal cancer in the liver. The spread via Glisson's capsule should be taken into consideration for complete tumor clearance.

Surgical treatment of liver metastases in patients with colorectal cancer.

The incidence of colorectal cancer in the United States is increasing. Because more than half of patients with colorectal cancer have liver metastases develop, the number of patients with hepatic metastases also is increasing. Unfortunately, metastatic disease will be limited to the liver in perhaps 25% of these patients and confined to only one lobe of the liver 25% of this subgroup. Consequently, solitary or unilobar colorectal metastases are found in as few as 5% of patients with colorectal cancer. The median survival of patients with unresected hepatic metastases is approximately 10.6 months. Patients with solitary lesions or small tumor burdens may attain a median survival of 16-20 months, but 5-year survivors are extremely rare. In contrast, rates of 5-year survival average approximately 36% after resections of solitary hepatic lesions and may approach the same level in selected patients with multiple lesions. Factors that appear to adversely effect survival include detection of metastatic disease because of signs or symptoms of disease, an elevated carcinoembryonic antigen (CEA) level, elevated liver function tests, poorly differentiated primary lesions, lymph node-positive primary lesions, extrahepatic sites of metastases, more than four hepatic lesions, bilobar disease, a satellite pattern of metastases in the liver, positive margins of the liver resection, positive extrahepatic lymph nodes, and more than 10 units of blood transfusion during the perioperative period. Operative mortality for liver resections should remain approximately 4%, and major morbidity should be in the range of 20-30%. Modalities other than surgical resection have not improved survival in patients with colorectal hepatic metastases. Thus, when feasible, patients with metastatic colorectal cancer limited to one lobe of the liver should undergo hepatic resection. Unfortunately, only approximately 5% of patients with colorectal cancer fall into this category, so resection of hepatic metastases can improve overall survival of patients with colorectal cancer by only 1-2%.

The Influence of Intraoperative Hypotension and Perioperative Blood Transfusion on Disease-free Survival in Patients with Complete Resection of Golorectal Liver Metastases

An increased interest in surgical treatment of liver metastases from colorectal origin has evolved recently. However not all patients benefit from this approach, with early recurrence and death still being encountered. To evaluate clinical as well as perioperative factors that might significantly affect the outcome of patients with completely resected colorectal liver metastases, we examined 116 patients who underwent resection between September 1987 and August 1989. Median follow-up time was 13.2 months (0.6 to 31.4 months). The overall survival rate was 91% at 1 year and 75% at 2 years. Median survival was not reached. Median disease-free survival time was 11.5 months, with 49.4% and 21.2% of the patients being free of disease at 1 and 2 years, respectively. By univariate analysis, site of primary colorectal cancer, preoperative carcinoembryonic antigen (CEA) level, size of metastases, number of metastases, length of operation time, percentage mean arterial pressure, number of hypotensive episodes, duration of hypotensive episodes, and whole blood transfusion significantly affected recurrence rate following resection. However only site of primary tumor, CEA, number of metastases, and number of hypotensive episodes remained significant in the multivariate analysis. The most significant single factor that affected recurrence rate was the number of hypotensive episodes during the operative procedure. It is concluded that hypotensive episodes, even when well controlled, should be avoided during operation to maximize the chances of cure and prolong disease-free survival of patients with colorectal liver metastases.

A CASE REPORT OF LEIOMYOSARCOMA OF THE RECTUM WITH RIGHT HEPATIC LOBECTOMY FOR LIVER METASTASIS

Leiomyosarcoma of the alimentary tract is a relatively uncommon disease, but recently, some cases have been reported in Japan. Because of the severe liver metastasis and poor prognosis, surgical treatment of liver metastasis of leiomyosarcoma has been rare.In a patient with leiomyosarcoma of the rectum, liver metastasis was diagnosed by abdominal CT scan, because of the presence of an intrahepatic low-density area. A right partial lobectomy was performed and liver metastasis of the leiomyosarcoma of the rectum was diagnosed histopathologically.Liver metastasis of leiomyosarcoma is difficult to diagnosis because its clinical findings often differ. It is important to diagnose liver metastasis early as possible, by means of ultrasonography and computed tomography. Further more, hepatectomy for metastasis of leiomyosarcoma is useful for treating this disease, so in general should be performed.

Temporary liver dearterialization in patients with metastatic carcinoid disease

AbstractThe surgical treatment of liver metastases from carcinoid tumors is burdened by a relatively poor symptomatic relief and a high mortality rate. Temporary liver dearterialization, separating the operative trauma from the temporary hepatic occlusion, may have advantages. We have utilized this treatment in 16 patients. The effect of treatment was registered in symptomatic relief, changes in urinary 5‐HIAA, serotonin in platelet‐poor plasma, and morphologic changes shown by angiography.Fourteen patients, who underwent only the dearterialization procedure, survived the immediate postoperative period, while 2 patients who had concomitant small bowel resection both died of complications, 1 and 3 months postoperatively, respectively. One patient died, 14 months postoperatively, of the carcinoid disease. All but 1 patient were free from symptoms for at least 6 months. Two patients have had no recurrence of the carcinoid syndrome for 34 and 42 months, respectively. A decrease in urinary 5‐HIAA was seen after 6 months in 10 patients, serotonin declined in 7 patients, and angiography showed regression in 7 patients. The results of this study indicate that temporary liver dearterialization is a safe procedure with low mortality and good symptomatic relief from the carcinoid syndrome.