Synchronous Hepatic Metastases Research Articles

A rare case of a malignant pheochromocytoma with synchronous hepatic metastasis in a 44-year-old male: a case report

A rare case of a malignant pheochromocytoma with synchronous hepatic metastasis in a 44-year-old male: a case report

Surgery for gastroenteropancreatic neuroendocrine tumors with synchronous liver metastasis

Background: Gastroenteropancreatic neuroendocrine tumors (GEP NETs) are most often diagnosed at an advanced stage with synchronous hepatic metastasis. Surgical management strategies for these patients are controversial, with Level I evidence lacking given the rarity of this diagnosis. We therefore used a national database to investigate survival outcomes associated with resection of primary tumor, resection of the liver metastases, or resection of both the primary tumor and liver metastases.

Comparison of surgical resection combined with chemotherapy and palliative chemotherapy for synchronous hepatic metastases from gastric cancer.

e16041 Background: Hepatic metastases of gastric cancer(HMGC) are an important factor affecting the prognosis of gastric cancer patients, and 3-14% of gastric cancer cases were diagnosed with synchronous hepatic metastases of gastric cancer (SHMGC). However, there remains much unidentified about the therapy effect of surgical resection on SHMGC. Here, we investigated the associations of surgical resection with the overall survival of SHMGC, which might develop more effective therapy strategies for patients of HMGC. Methods: Patients diagnosed with SHMGC from January 2010 to December 2015 were selected in the study. Kaplan-Meier analysis and multivariable analysis based on the Cox proportional hazards model were performed to compare the effects of surgical resection (including gastrectomy and metastasectomy) combined with chemotherapy (surgical resection group, SR group) and palliative chemotherapy (palliative chemotherapy group, PC group) on survival. Results: A total of 132 patients were enrolled in this study. Overall, 57 (43.2%) were treated with surgical resection/chemotherapy and 75 (56.8%) palliative chemotherapy. Overall survival (OS) was significantly prolonged in the SR group compared with the PC group (33.6 vs. 12.4 months, P < 0.001). In the SR group, the R0 resection (68.4%, 39/57) contributed to markedly prolonged OS compared with the non-R0 resection subgroup (45.1 vs. 13.5 months, P < 0.001). Surgical resection and single hepatic metastasis were independent predictors of OS in multivariate analysis with hazard ratio (HR) of 0.453 (95% confidence interval [CI] 0.276-0.813, p = 0.009) and 0.540 (95%CI 0.315-0.796, p = 0.043), respectively. Conclusions: For patients with synchronous hepatic metastases of gastric cancer, radical surgical resection combined with appropriate chemotherapy may be more beneficial than palliative chemotherapy. Moreover, single hepatic metastasis might achieve better survival after aggressive surgical resection.

Surgical management for pancreatic neuroendocrine neoplasms with synchronous hepatic metastases: A literature review

Pancreatic neuroendocrine neoplasms (pNENs) are a group of heterogeneous neoplasms originating from pancreatic neuroendocrine cells. In recent years, with the development of diagnostic technology, the incidence has increased in the past decades. The surgical treatment for pNEN with synchronous hepatic metastasis (sHM) is complicated, and the indications and prognosis are still controversial. This review provides a comprehensive update of current evidence and progress in guideline recommendations for pNEN-sHM to improve surgical management.

Which surgical strategy for colorectal cancer with synchronous hepatic metastases provides the best outcome? A comparison between primary first, liver first and simultaneous approach.

There is no clear consensus about the best surgical strategy for patients with colorectal cancer (CRC) and synchronous liver metastases (SCRLM). Between 2009 and 2019, patients with CRC and SCRLM considered for curative treatment were included. Perioperative and follow-up data were analysed to examine the safety and survival outcomes of primary first (PF), liver first (LF) and simultaneous resection (SR) strategies. 204 patients were identified, consisting of PF (n = 129), LF (n = 26) and SR (n = 49). Forty-five patients (22.1%) failed to have either the primary or the liver metastases resected following initial LF (n = 11, 42.3%) or PF (n = 34, 26.4%), respectively (p < 0.001). The postoperative morbidity rates were 31.0%, 38.4% and 40.8% in PF, LF and SR group, respectively (p = 0.409); the mortality rates were 2.3%, 0% and 4.1%, respectively (p = 0.547). The 1-, 3- and 5-year overall survival (OS) were 94%, 72%, 53% in the PF group, 74%, 54%, 36% in the LF group, and 91%, 74%, 63% in the SR group. LF group had the worst OS compared to PF and SR (p = 0.040, p = 0.052). The 1-, 3- and 5-year disease-free survival (DFS) were 31%, 15%, 10% in PF, 21%, 9% and 9% in LF and 45%, 28% and 28% in SR group, respectively. SR group had a better DFS compared to PF and LF (p = 0.005, p = 0.008). At the multivariate analysis, there was no difference between the three strategies in terms of OS (PF vs SR OS-HR 1.090, p = 0.808; LF vs SR OS-HR 1.582, p = 0.365) and the PF had a worse DFS compared to the SR approach (PF vs SR DFS-HR 1.803, p = 0.007; LF vs SR DFS-HR 1.252, p = 0.492). PF, LF and SR had comparable postoperative morbidity and mortality. The three surgical strategies had similar OS outcomes. The PF strategy was associated with a worse DFS than SR, while the LF approach was associated with a high failure rate to progress to the second stage (primary tumour resection).

Impact of recommendations and new therapies on the prognosis of colon cancer with synchronous liver metastasis

To assess the prognostic impact of the new therapies recommended over the past twenty years for colonic cancers with synchronous hepatic metastasis (hmCC). From 1995 to 2016, 802 hmCC were identified in a tumor registry. An univariate and multivariate analysis looked for the impact of the different recommendations over three periods: chemotherapy without targeted therapy (p1CH), chemotherapy with targeted agent in 2nd line (p2TA2), chemotherapy with TA in 1st line (p3TA1) depending on anatomoclinical criteria and therapeutic sequences: chemotherapy then resection of the primary tumor (CR) (n=100), resection of the primary tumor then chemotherapy (RC) (n=541), chemotherapy alone with or without TC (onlyCH) (n=161). The rates of onlyCH, CR and RC had varied respectively during these 3 periods from 12% to 26%, 6% to 21% and from 82% to 53% (p=0.001). The medians of p1CH, p2TA2 and p3TA1 survival were 20.2, 22.7 and 23.6 months, respectively (p=0.12). The independent factors of poor prognosis were age ≥ 75 years (1.6 [1.35; 1.9] p=0.0001), chemotherapy only 2.3 [1.6; 3.5] p=0.0001), p1CH 1.7 [1.4; 2.1] p<0.0001), p2TA2 1.2 [1.02;1.6] p=0.04. The p2TA2 period had a worse prognosis than p3TA1 (1.25 [1.01; 1.5] p=0.03). In public health point of view, the recommendation of first-line TA improved survival and increased rate of primary tumor resection after chemotherapy.

346 Meta-Analysis of Simultaneous Versus Staged Colorectal and Hepatic Resections for Colorectal Cancer with Synchronous Hepatic Metastases

Abstract Aim To evaluate the comparative outcomes of simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases Method We conducted a systematic search of electronic information sources, and bibliographic reference lists. Perioperative morbidity and mortality, anastomotic leak, wound infection, bile leak, bleeding, intra-abdominal abscess, sub-phrenic abscess, reoperation, recurrence, 5-year overall survival, procedure time, and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using random-effects models. Results We identified 41 comparative studies reporting a total of 12,081 patients who underwent simultaneous (n = 5,013) or staged (n = 7.068) resections for colorectal cancer with synchronous hepatic metastases. The simultaneous resection was associated with significantly lower rate of bleeding (OR: 0.60, p = 0.03) and shorter length of hospital stay (MD:-5.40, p &amp;lt; 0.00001) compared to the staged resection. However, no significant difference was found in perioperative morbidity (OR:1.04, p = 0.63), mortality (RD:0.00, p = 0.19), anastomotic leak (RD:0.01, p = 0.33), bile leak (OR:0.83, p = 0.50), wound infection (OR:1.17, p = 0.19), intra-abdominal abscess (RD:0.01, p = 0.26), sub-phrenic abscess (OR:1.26, p = 0.48), reoperation (OR:1.32, p = 0.18), recurrence (OR:1.33, p = 0.10), 5-year overall survival (OR:0.88, p = 0.19), or procedure time (MD:-23.64, p = 041) between two groups. Conclusions Despite demonstrating nearly comparable outcomes, the best available evidence (level 2) regarding simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases is associated with major selection bias. It is time to conduct high quality randomised studies with respect to burden and laterality of disease. We recommend the staged approach for complex cases.

Examining Perioperative Risk Associated with Simultaneous Resection of Primary Neuroendocrine Tumors and Synchronous Hepatic Metastases.

Surgical debulking of primary neuroendocrine tumors (NETs) and hepatic resection of metastatic NET disease may each independently improve overall survival. However, evidence for combined primary site debulking and metastasectomy on survival and impact on short-term perioperative outcomes is limited. The 2014-2016 ACS-NSQIP targeted hepatectomy database was queried for all patients undergoing liver resection for metastatic NET. Secondary procedure codes were evaluated for major concurrent operations. Multivariable analysis was performed to determine risk factors for 30-day morbidity and mortality. A total of 472 patients were identified, of whom 153 (32.4%) underwent ≥1 additional concurrent major operation. The most common concurrent procedures were small bowel resection (14.6%), partial colectomy (8.9%), and radical lymphadenectomy (7.4%). Among all patients, overall 30-day mortality and morbidity were 1.5% and 25.6%, respectively. Modifiable and treatment-related factors associated with increased major postoperative morbidity risk included >10% weight loss within six months of surgery (p = 0.05), increasing number of hepatic lesions treated (p = 0.05), and biliary reconstruction (p = 0.001). No major concurrent procedure was associated with increased 30-day morbidity (all p > 0.05). Approximately one-third of patients with stage IV NET underwent combined hepatic and multi-organ resection. Although modifiable and treatment-related factors predictive of perioperative morbidity were identified, performance of concurrent major procedures did not increase perioperative morbidity. These results support consideration of multi-organ resection in carefully selected patients with metastatic NET.

Multimodal and Mini-Invasive Treatment of a Multifocal Metastatic Mid-Gut Neuroendocrine Tumor: A Surgical Case Report

Neuroendocrine tumors represent the most common small bowel malignancy. At the time of presentation, they often debut as metastatic disease. Consensus guidelines recommend a multimodal and multidisciplinary approach that includes punctual investigations, aggressive surgical resection of the primary tumor and the assessment of possible synchronous metastasis through surgical procedures or ablative techniques. This report details the case of a 77-year-old male with a multifocal mid-gut neuroendocrine tumor with nodal dissemination and synchronous hepatic metastasis. He underwent a laparoscopic procedure that included an ileal resection with intracorporeal side-to-side ileo-ileal anastomosis, a large mesenteric nodal dissection extended up to superior mesenteric vein, a laparoscopic dissection of hepatic metastasis and an ultra-soundguided thermal ablation of two hepatic metastasis. This case highlights the efficacy of laparoscopy, providing a mini-invasive radical treatment and the importance of an aggressive multimodal approach in facing a metastatic multifocal mid-gut neuroendocrine tumor.

Simultaneous versus staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases: a meta-analysis of outcomes and clinical characteristics.

To evaluate the comparative outcomes and clinical characteristics of simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases. We conducted a systematic search of electronic information sources, and bibliographic reference lists. Perioperative morbidity and mortality, anastomotic leak, wound infection, bile leak, bleeding, intra-abdominal abscess, sub-phrenic abscess, reoperation, recurrence, 5-year overall survival, procedure time, and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using random-effects model. We identified 41 comparative studies reporting a total of 12,081 patients who underwent simultaneous (n = 5013) or staged (n = 7068) resections for colorectal cancer with synchronous hepatic metastases. There were significantly lower use of neoadjuvant chemotherapy (p = 0.003), higher right-sided colonic resections (p < 0.00001), and minor hepatic resections (p < 0.00001) in the simultaneous group. The simultaneous resection was associated with significantly lower rate of bleeding (OR 0.60, p = 0.03) and shorter length of hospital stay (MD - 5.40, p < 0.00001) compared to the staged resection. However, no significant difference was found in perioperative morbidity (OR1.04, p = 0.63), mortality (RD 0.00, p = 0.19), anastomotic leak (RD 0.01, p = 0.33), bile leak (OR 0.83, p = 0.50), wound infection (OR 1.17, p = 0.19), intra-abdominal abscess (RD 0.01, p = 0.26), sub-phrenic abscess (OR 1.26, p = 0.48), reoperation (OR 1.32, p = 0.18), recurrence (OR 1.33, p = 0.10), 5-year overall survival (OR 0.88, p = 0.19), or procedure time (MD - 23.64, p = 041) between two groups. Despite demonstrating nearly comparable outcomes, the best available evidence (level 2) regarding simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases is associated with major selection bias. It is time to conduct high-quality randomised studies with respect to burden and laterality of disease. We recommend the staged approach for complex cases.

Simultaneous Versus Staged Resection of Colorectal Cancer Liver Metastasis: A Retrospective Single-Center Study

BackgroundFor patients with colorectal cancer and synchronous liver metastasis, either a simultaneous, or a two-staged resection of the primary tumor and the liver metastases is possible. There are currently no guidelines preferring one approach to the other. Material and methodsConsecutive patients who underwent hepatic resection at our university hospital from 2007-2016 were included. Clinical, histopathologic, serologic, and survival data were analyzed. The primary end point was tumor-specific survival for patients with simultaneous versus staged resections. ResultsOf all 140 patients, 68 underwent simultaneous resection and 72 underwent staged resection. The characteristics of both groups were comparable. Patients with simultaneous resections had a shorter duration of cumulative operation time (299 versus 460 min; P = 0.003) and a shorter cumulative length of hospital stay (23 versus 43 d; P = 0.002). Perioperative mortality (P = 0.257) did not differ significantly; however, patients with simultaneous resections had higher rates of grade 2 complications according to Clavien-Dindo (P < 0.001). Tumor-specific 1-y survival was 85 ± 5% for simultaneous and 83 ± 5% for staged resection (P = 0.631). On multivariable analysis, pT4 (P = 0.038), pN3 (P = 0.003), and G3/4 (P = 0.041) of the primary tumor and postoperative complications (Clavien-Dindo 3/4/5, P = 0.003) were poor prognostic factors regarding tumor-specific survival. ConclusionsThis is one of the largest and most thoroughly documented retrospective single-center studies of consecutive patients with synchronous hepatic metastases. Simultaneous resection of colorectal cancer together with hepatic metastases is a safe procedure in selected patients and does not have a significant influence on long-term survival.

172P - Preoperative neutrophil‐to‐lymphocyte ratio (NLR) predicts recurrence after surgery in patient with pancreatic neuroendocrine neoplasm (PanNEN)

BackgroundSeveral inflammation-based markers were found to have a prognostic value in malignancies. Recent studies have reported that the preoperative neutrophil-to-lymphocyte ratio (NLR) is useful for prognostication in a variety of oncologic patients. We analyzed the NLR in determining Pancreatic neuroendocrine neoplasm (PanNEN) clinical outcomes after surgery. MethodsWe evaluated 132 consecutive cases of PanNEN who underwent surgery in Tohoku University Hospital between May 2001 and December 2018. Eight patients with synchronous hepatic metastasis, two patients with NEC, one patient with an active infection at blood sampling, and one patient with R2 noncurative resection were excluded from the study. 120 patients divided into two groups according to the values of NLR based on the receiver operator characteristic (ROC) curve. Differences of the characteristics between the two NLR groups (<3.84 vs. ≥3.84) were investigated with the chi-squared test and the Wilcoxon rank-sum test. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated by univariate or multivariate analyses using Cox’s proportional hazards model. ResultsThe median age was 60 years old (range 12-88). In the WHO2017 histological grade, NET G1, G2, and G3 included 74, 44, and 2 cases, respectively. The median follow-up period was 52.9 months (range, 1-182). The NLR values distributed between 0.44 and 5.32 (average 1.92 ± 0.88). Five- and ten‐year RFS was 90.4% and 80.1%, respectively. Ten (8.3%) cases of relapse were observed. The site of recurrence was liver in nine patients and lymph node metastasis in one. NLR showed a significant correlation with RFS (median RFS time, 44.6 months (NLR ≥ 3.84) and not reached (NLR <3.84), p < 0.001). The multivariate analysis identified ki67 (≥3.4 HR 8.9; 95% CI 2.14 to 60.3; P = 0.002), and preoperative NLR (≥3.84 HR 7.7; 95% CI 1.63 to 30.1; P = 0.013) were an independent predictor of recurrence. ConclusionsNLR could be a useful prognostic marker of the recurrence estimation after surgery and a handy objective screening tool for the host immune response in patients with PanNEN. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

1405P - Validation of a tumour mutational burden workflow on routine histological samples of colorectal cancer and assessment of a cohort with synchronous hepatic metastases

BackgroundColorectal carcinoma 5-year survival ranges from 90% in patients with localized disease to 15% for those with distant metastasis. Recent research has suggested that hypermutation may predict response to immunotherapy in these tumors, but routine tests for microsatellite (MS) instability miss tumours which acquire hypermutation through other mechanisms. Tumour mutational burden (TMB) measured by next-generation sequencing has been proposed to overcome this limitation. MethodsA commercially available next-generation sequencing panel targeting 409 cancer-relevant genes was validated for TMB measurement using 12MS stable and 14MS instable metastatic colorectal carcinomas, defined by routine testing of MS loci. The same panel was applied to 53 untested colorectal carcinomas with matched synchronous metastases, collected across 10 years to determine both their TMB and presence of KRAS/BRAF mutations. ResultsAll samples could be sequenced at a mean coverage depth of 766x and uniformity of 97%. Mean TMB (mutations/megabase) was 8.84 for MS stable vs. 33.36 for MS instable cases in the assay validation cohort. A cut-off value of 15.56 reached 100% sensitivity (95% CI 77-100%) and 100% specificity (95% CI 73-100%). Analysis of the 10 years cohort showed KRAS mutation in 25 cases and BRAF mutation in 4; automated TMB analysis was feasible for samples collected within 7 years (n=16), while in older specimens DNA deamination caused artefactual calls. 14 cases showed a low TMB in both primary and metastasis, one MS instable case showed high TMB in both primary and metastasis, and one MS stable case showed low TMB (11.61) in the primary and a higher TMB (21.37) in the metastasis. The mutational signature of the metastatic sample showed C>A transversions (11%), missing in the primary tumour, suggesting an additional mutational mechanism. ConclusionsGene panel-based TMB analysis can be performed on routine histology samples to detect both hypermutation and cancer relevant somatic mutations. Analysis of older samples may lead to deamination artifacts, which can however be revealed by mutational signature analysis. Legal entity responsible for the studyAldo Scarpa (ARC-NET Cancer Research Centre). FundingAssociazione Italiana Ricerca Cancro [AIRC grant n. 12182]. DisclosureAll authors have declared no conflicts of interest.

Synchronous liver metastases and peritoneal carcinomatosis from colorectal cancer: different strategies for curative treatment?

Management of patients with resectable hepatic metastases (HMs) and colorectal peritoneal carcinomatosis (CRPC) is not currently standardised. The aims of this study were to evaluate the safety of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and hepatic surgery for patients with CRPC with synchronous hepatic metastases (HM), and its impact on survival rates. A retrospective analysis was performed, including patients undergoing CRS/HIPEC for CRPC from 2007 to September 2016 in two groups, with (HM+) and without (HM-) synchronous hepatic metastases. Patients with extra-abdominal metastases were excluded. The hepatic strategy was described. Morbimortality and survival were compared between the two groups. One hundred nine patients underwent CRS/HIPEC for CRPC with or without hepatic surgery with curative intent: 33 patients with (HM+) and 76 patients without (HM-) synchronous HM. The median follow-up was 30months. All patients with HM (HM+) received neoadjuvant chemotherapy vs. 88.1% in the HM- group (p = 0.04) associated with monoclonal antibody in 66.6% of cases in the HM+ group vs. 57% in the HM- group (p = 0.01). In the HM+ group, two steps were implemented to treat peritoneal and hepatic metastases in 15 patients (45%). In this group, planned hepatic resection in two procedures was performed for eight patients, all presenting bilobar HM. Postoperative morbidity did not differ between the two groups. No deaths occurred. Median overall survival (OS) and recurrence-free survival (RFS) were 31 and 65months (p = 0.188), versus 21 and 24months (p = 0.119), respectively, in the HM+ versus HM- groups. In multivariate analysis, the peritoneal cancer index (PCI) was the only significant prognostic factor whereas synchronous HM was not a significant prognostic factor. Curative surgical treatment for CRPC with synchronous HM seems to be feasible and safe, and could facilitate long survival rates, compared to patients without HM. The hepatic strategy is not standardised. However, a "two-step" surgical strategy could be proposed in order to reduce postoperative morbidity rates.

How to approach rectal carcinoma with potentially resectable synchronous hepatic metastases role of medical oncology

How to approach rectal carcinoma with potentially resectable synchronous hepatic metastases role of medical oncology

One-stage pure laparoscopic resection of primary colorectal cancer and synchronous hepatic metastases: a single institution experience

One-stage pure laparoscopic resection of primary colorectal cancer and synchronous hepatic metastases: a single institution experience

One-stage pure laparoscopic resection of primary colorectal cancer and synchronous hepatic metastases: a single institution experience

Background: Simultaneous pure laparoscopic resection (SPLR) of the primary colorectal cancer and synchronous liver metastases (LM) is rarely performed. The aim of this study is to review a single institution experience. Methods: Between 2012 and 2016, 64 patients underwent laparoscopic liver resection for various benign and malignant liver tumors. The analysis included SPLR. The primary outcomes of this study were clinical and pathological variables. The secondary outcome was survival. Results: Eight patients underwent SPLR with laparoscopic colectomy (n = 3) and proctectomy (n = 5). Liver resections included only minor surgery: left lateral sectionectomies (n = 4) and atypical resections (n = 4). Average operating time was 270 minutes (range 180 - 390 minutes). Estimated blood loss was in average 380 mL (range 50-600 mL). Conversion to open procedure was performed in one patient. All patients had only one LM and the size was in average 2.6 cm (range 1 – 5 cm). R0 resection was achieved in all cases. Resection margin was in average 6.8 mm (range 2-15 mm). Median (range) hospital stay was 9 (7-42) days. The number of major morbidity was: 1 (Clavien-Dindo 3B), and there was no postoperative mortality. Median follow-up for surviving patients was 13 months. Six patients are alive with no evidence of disease, one patient is alive with disease and one patient died of disease. Conclusion: SPLR is feasible and safe for treatment of synchronous LM and there is no compromise of oncological surgical principles.

Gastric cancer with synchronous and metachronous hepatic metastasis predicted by enhancement pattern on multiphasic contrast-enhanced CT

ObjectiveThe purpose of this study was to examine the relationship between the CT features of the primary-site gastric cancer and the concurrent existence or postoperative recurrence of hepatic metastasis. Materials and methodsFrom January 2013 to July 2016, 125 patients with advanced gastric cancer who were evaluated by gastroscopy and contrast-enhanced CT at our institution were included. Eleven patients had hepatic metastasis at the time of diagnosis (synchronous hepatic metastasis). Five patients had hepatic recurrence after surgery (metachronous hepatic metastasis, median follow-up period of 313 days), and another 56 patients had no hepatic recurrence during follow-up period (negative hepatic metastasis, median follow-up period of 1102 days). Two radiologists independently reviewed the CT images and they determined the peak enhancement phase, and then measured the CT attenuation value of the gastric lesion for each phase. We compared the parameters of synchronous, metachronous and negative hepatic-metastasis. We calculated diagnostic performance of CT for diagnosing synchronous and metachronous hepatic metastasis. ResultsThe peak enhancement was significantly diff ;erent between the three groups for both readers (reader 1, p = 0.0001; reader 2, p = 0.0002). Most of the synchronous and metachronous hepatic metastasis had peak enhancement in the arterial or portal phase. The CT attenuation values of synchronous and metachronous hepatic metastasis were significantly higher than those of negative hepatic metastasis in the delayed phase according to both readers (reader 1, p = 0.0003; reader 2, p = 0.0002). In predicting synchronous hepatic metastasis using peak enhancement, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 72.7%, 89.3%, 57.1%, 94.3%, and 86.6% for reader 1, and 54.5%, 94.6%, 66.7%, 91.4%, and 88.1% for reader 2. In predicting metachronous hepatic metastasis, the sensitivity, specificity, PPV, NPV, and accuracy were 60.0%, 89.3%, 33.0%, 94.3%, and 86.9% for reader 1, and 40.0%, 94.6%, 40.0%, 94.6%, and 90.2% for reader 2. ConclusionOur study showed that gastric cancer with synchronous and metachronous hepatic metastasis tends to show early enhancement with a washout pattern on contrast-enhanced CT. This feature would be helpful in image surveillance for synchronous or metachronous hepatic metastasis of gastric cancer.

The Role of Surgical Resection for Stage IV Gastric Cancer With Synchronous Hepatic Metastasis

BackgroundWith improved responses to chemotherapy and targeted treatments, the role of surgery in metastatic gastric cancer (MGC) to the liver needs to be revisited. We sought to examine whether surgical resection is associated with improvement of long-term survival. MethodsThe National Cancer Database was queried for MGC to the liver (2010-2014). Survival analysis was performed to compare the effect of gastrectomy and perioperative chemotherapy (G-CT) to palliative chemotherapy (PCT) alone. ResultsWe identified 3175 patients with MGC to the liver. Most patients (94%, n = 2979) were treated with PCT, whereas 6% (n = 196 patients) underwent G-CT. Overall survival improved in patients treated with G-CT compared to PCT alone (16 versus 9.7 mo, P < 0.001). In patients undergoing G-CT, neoadjuvant chemotherapy was associated with increased overall survival compared to adjuvant chemotherapy (18.9 versus 14.8 mo, P = 0.011). Hazards of death significantly decreased with gastrectomy (hazard ratio [HR]: 0.53, 95% confidence interval [CI]: 0.44-0.63, P < 0.001). Negative prognostic factors included advanced age (HR: 1.10, 95% CI: 1.06-1.14, P < 0.001), treatment at nonacademic institution (HR: 1.23, 95% CI: 1.13-1.33, P < 0.001), and poorly differentiated grade (HR: 1.54, 95% CI: 1.17-2.03, P < 0.001). ConclusionsG-CT is associated with improved survival in patients with gastric cancer and synchronous liver metastasis. Further experience with well-designed prospective trials may be warranted to confirm these findings.

Disparities in resection of hepatic metastases in colon cancer.

Evidence suggests that resection of synchronous hepatic metastases (SHM) in stage IV colon cancer is safe and can improve survival in select patients. Little is known, however, about the use of hepatic resection in this setting on a population level. The aim of this study was to describe trends in resection rates of SHM in patients with stage IV colon cancer using a large national cohort database. A retrospective cohort study was performed of stage IV colon cancer patients during 2000-2011 in Surveillance, Epidemiology and End Results (SEER) Medicare data who had diagnosis codes confirming SHM. Univariate and multivariate logistic regression were used to identify patient factors related to receipt of hepatic resection. There were 11,351 patients with colon cancer and SHM. Of these patients, 465 (4.1%) underwent surgical hepatic resection. The proportion increased steadily over time from 2000-2002 (3.5%) to 2009-2011 (5.1%) (P=0.03). Patients who were older with higher comorbidity burden were less likely to undergo hepatic resection. Additionally, the odds of hepatic resection were 30% lower for African-American patients than for white patients (OR 0.70, P=0.05). Odds of hepatic resection were 44% lower for patients from ZIP Codes with >20% poverty than for patients from areas with <5% poverty (OR 0.56, P<0.001). Interestingly, among patients who underwent no surgical treatment at all, only 25% saw a surgeon after diagnosis. This number increased over time from 21.6% in 2000 to 29.1% in 2011 (P<0.001). Similar disparities noted above were seen with surgical evaluation for hepatic resection. Despite evidence supporting the safety and efficacy of hepatic resection in the setting of SHM, few patients are seen by surgeons and go onto receive hepatic surgery. Additionally, access to hepatic resection is notably lower for African Americans and patients from areas with higher poverty rates.