Synchronous Colorectal Cancer Metastases Research Articles

Comparison of laparoscopic and open simultaneous surgeries for synchronous metastases of colorectal cancer in the liver: meta-analysis

Aim. To analyze studies focused on comparing laparoscopic and open simultaneous surgeries for synchronous metastases of colorectal cancer in the liver.Materials and methods. The electronic databases PubMed, Web of Science, Scopus, Embase, Cochrane Library were searched for the studies focused on the comparison of open and laparoscopic simultaneous surgeries for synchronous metastatic liver lesions, dated till October 20, 2020. Keywords: simultaneous resections, colorectal cancer, liver metastases, simultaneous laparoscopic.Results. Meta-analysis contains the results of 1211 simultaneous surgeries for simultaneous metastases of colorectal cancer in the liver: 450 laparoscopic and 761 open surgeries. Laparoscopic surgery was characterized with lower blood loss [weighted mean difference (WMD) = -131.77, 95% CI: -232.54 to -31.00, p = 0.01], a shorter postoperative hospitalization [WMD = -2.87, 95% CI: -3.41 to -2. 33, p < 0.00001], early first bowel movement [WMD = -0.99, 95% CI: -1.40 to -0.58, p < 0.0001], early initiation of enteral feeding [WMD = -1.20, 95% CI: -2.06 to -0.33, p = 0.007]), lower incidence of postoperative complications [OR = 0.60, 95% CI: 0.46–0.80, p = 0.0004]. A statistically significant advantage of laparoscopic access was established in overall [OR = 0.80, 95% CI: 0.64–0.99, p = 0.04] and recurrence-free survival [OR = 0.73, 95% CI: 0.60–0.89, p = 0.002].Conclusion. Perioperative and distant oncologic outcomes demonstrate safety and efficacy of laparoscopic simultaneous interventions for synchronous metastases of colorectal cancer in comparison with open interventions.

Prognosis of the combination therapy results in patients with synchronous metastases of colorectal cancer

Objectives - to optimize the indications for radiofrequency thermal ablation in patients with synchronous multiple metastases of colorectal cancer to the liver on the basis of prognostic treatment results. Material and methods. The study group included 78 patients with colorectal cancer with synchronous multiple bilobar liver metastases, who have underwent combined treatment in the period of 2007- 2015, such as cytoreductive surgery removing the primary intestinal tumor in combination with RFA of metastases in the liver, followed by chemotherapy. Results. A computer program for preoperative risk assessment of disease progression was developed and introduced in clinical practice. It is based on the results of the analysis of the factors, predicting the risk of relapse during the first year after cytoreductive surgery with RFA of synchronous multiple CRC liver metastases. Conclusion. The index of metastatic liver damage (the product of the sum of the diameters of metastatic liver lesions by their number), the mutational status of the KRAS gene, CEA values are significant factors in predicting the progression of the disease, which can optimize indications for radiofrequency thermal ablation in the treatment of patients with stage IV CRC with synchronous metastases to the liver.

Prognosis in patients with synchronous colorectal cancer metastases after complete resection of the primary tumor and the metastases

Synchronous metastases are considered a negative prognostic factor in patients with metastatic colorectal cancer (CRC). We investigated the outcomes of stage IV CRC patients undergoing complete gross resection (R0/1) of both the primary tumor and the metastases under the guidance of a multidisciplinary team (MDT). All CRC patients with synchronous metastases were retrieved from a prospective database. Patients treated from 2006 to 2017 who underwent complete resection were analyzed. Various factors, including multiple metastatic sites and complex procedures, were investigated. Univariate and multivariate overall survival (OS) calculations were performed. Of 330 consecutive patients with synchronous metastases, 101 (30.6%) achieved an R0/1 status including 12 (11.9%) patients with multiple metastatic sites. Complex procedures were necessary in 45 (44.6%) patients. Five-year OS was 53.0% for the R0/1 patient group. Multivariate analysis could not detect factors associated with prognosis. With modern treatment, the prognosis of patients with synchronous CRC metastases can be improved. Decisions made by a MDT offered one-third of patients a potentially curative approach to their stage IV disease. Despite the treatment of a high rate of patients with complex metastases necessitating complex procedures, we achieved a favorable 5-year OS rate.

REGIONAL CHEMOTHERAPY IN TREATMENT FOR UNRESECTABLE COLORECTAL CANCER METASTASES TO THE LIVER RESISTANT TO SYSTEMIC CHEMOTHERAPY

Aim. To determine the effectiveness of regional chemotherapy (RChT) in the treatment of patients with unresectable colorectal metastases to the liver, resistant to systemic chemotherapy (SChT). Materials and methods. Between 2011 and 2017, we treated 60 patients with unresectable colorectal metastases to the liver, resistant to SChT from 2011 to 2017 y. All patients received previously 3-35 cycles of SCht which were ineffective in 54 and was discontinued in 6 patients because of grade III-IV toxicity. In all patients, antitumor drugs which were most effective in SChT were used for RChT,. In the absence of effect on any schemes of SChT, monotherapy with the Mitomycinum C was done. Hepatic arterial infusion (HAI) was carried out for hypovascular metastases using 4-6 gr 5-fluorouracil, 15-20 mg mitomycinum C, 150-200 mg oxaliplatinum, 160200 mg irinotecan. Transcatheter arterial chemoembolization (TACE) for hypervascular metastases was performed by selective infusion of suspension of Lipidol with chemotherapeutic drug: mitomycin C 10-20 mg or irinotecan 160-200 mg or doxorubicinum 50-80 mg and followed by arterial occlusion by gelfoam. Combination, TACE+HAI, was performed with difficult anatomical variants of hepatic artery. Results. We performed 222 cycles of RChT (from 2 to 15, average 6 per patient). There were no complication and lethality. Time to progression after the onset of RChT was 12.4 months in both groups. The median survival from the start of the first cycle SChT was 22 mo in the group with synchronous metastases of colorectal cancer to the liver and 23 mon for metachronic group. Conclusion. Our preliminary results showed prospect of using RChT in the treatment of patients with chemo-resistant colorectal metastases to the liver.

One-stage Combined Operations in Patients with Colorectal Cancer and Synchronous Liver Metastases

Aim. To evaluate the effectiveness of simultaneous combined operations in patients with synchronous metastases of colorectal cancer in the liver. Material and Methods. Liver resections were performed in 35 patients. 17 patients with synchronous metastases (main group) underwent one-stage combined operations: removal of the primary tumor and liver metastases within single surgical procedure. 18 control patients with metachronous metastases isolated liver resections were performed. Advanced liver resections dominated in both groups. Results. Postoperative mortality was absent in both groups. The average duration of operation in main group was 230 minutes. Thus it exceeded the same parameter in the control group at 75 minutes. The incidence of complications in the main group was insignificantly higher than in the control due to general surgical complications. Among them postoperative wound suppuration and lymphorrhea dominated. Mean duration of postoperative period in main group 2 bed-day surpassed that in the control group. The median survival in patients of the main group was 37 months, in the control group – 32 months. Conclusion. One-stage combined operations in patients with synchronous colorectal cancer metastases in the liver is accompanied by an acceptable incidence of postoperative complications and encouraging long-term results and therefore it looks very reasonable and promising

SIMULTANEOUS RESECTIONS FOR SYNCHRONOUS COLORECTAL CANCER LIVER METASTASES

BACKGROUND. The choice type of surgery between staged and simultaneous operations remains an actual issue in patients with colorectal cancer with synchronous liver metastases. The aim of this prospective study is to compare Short-term outcomes of patients with synchronous colorectal liver metastases treated by simultaneous or staged surgery. METHODS. 172 suitable patients were treated in State Scientific Centre of coloproctology named after А.N. Ryzhih, Moscow, Russia between January 2013 and February 2017. Simultaneous colorectal and hepatic resections were performed in 128 patients; 44 patients underwent delayed hepatectomy. Short-term outcomes were compared in patients who underwent simultaneous colorectal and hepatic resection and staged surgery depending on the demographic, clinical and morphological characteristics and type of operations. RESULTS. Median size and number of metastases in the liver were significantly smaller in the group of simultaneous operations: 2.2 cm vs 3.2 cm (p=0.034) and 2 vs 3.5 (p=0.0001), respectively. Major liver resections were rarely performed in group of simultaneous operations: 20 % vs 61 % (р=0,0001). Mortality and complications rates were similar in both groups: 1 % vs 2% (p=0,98) and 30% vs 45 % (р=0,08), respectively. Median days after surgery were also similar in both groups: 14 (12-21) vs 14 (12-21) days, (р=0,6), respectively. Median bloodloss in cases of major liver resections in group of simultaneous operations was lower than in analogical group in staged surgery: 345 ml vs 900 ml (р=0,007), respectively. There was no difference in mortality and complications rates between major liver resections in both groups: 0 vs 4 % (p=0,98) and 52 % vs 48 % (p=1,0), respectively. Rates of acute hepatic insufficiency were similar in both groups of major liver surgery: 4 % vs 11 %, (p=0,36). Median inpatient days were also similar in both groups of major liver surgery: 19 (15-27) vs 19 (11-27) days (р=0,1), respectively. CONCLUSION. Simultaneous operations, requiring economical resections are indicated in cases of synchronous metastases of colorectal cancer in the liver. Simultaneous major liver surgery do not lead to increased bloodloss, complications, mortality rates and inpatient days regardless on type of colorectal surgery in cases of synchronous colorectal cancer liver metastases.

Occurrence and survival of synchronous pulmonary metastases in colorectal cancer: A nationwide cohort study

ObjectiveTo investigate the occurrence of synchronous colorectal cancer metastases (SCCM) confined to the lungs, risk factors for these metastases and their impact on survival. MethodsIn a nationwide cohort study of 26,200patients data were prospectively entered into the Danish Colorectal Cancer Group’s (DCCG’s) database between May 2001 and December 2011. The recorded data were merged with data from the Danish Pathology Registry and the National Patient Registry. Multivariable logistic- and extended Cox regression analyses were used to adjust for confounding variables. ResultsIn total, 1970 patients (7.5%) had pulmonary SCCM of whom 736 (37%) had metastases exclusively in the lungs. Advanced age, recent years of diagnosis and a rectal index cancer were significantly associated with pulmonary SCCM. Adjustment for excess use of thoracic CT scans in rectal cancer patients did not alter this association (adjusted OR=1.81 (95% CI: 1.46–2.25, P<0.001)). Patients subjected to pulmonary metastasectomy, resection of primary tumour and chemotherapy had a superior overall survival compared with non-treated patients, especially when these therapeutic modalities were combined. ConclusionsThe occurrence of pulmonary SCCM was higher than previously reported and had a severe impact on survival. Our analyses suggest that pulmonary metastasectomy, resection of the primary tumour and chemotherapy may be a sound strategy in patients with confined pulmonary SCCM, but the risk of selection bias and consequent exaggeration of the treatment effect should be kept in mind. This study may serve as a reliable un-biased reference for future evaluation on detection strategies and potential therapeutic interventions.

Is surgical resection justified for stage IV colorectal cancer patients having bilobar hepatic metastases?—an analysis of survival of 77 patients undergoing hepatectomy

Surgical indication for stage IV colorectal cancer patients with bilobar hepatic metastases may be controversial. Retrospective cohort analysis was performed using data of 200 patients who underwent surgical resections for synchronous metastases of colorectal cancer between 1990 and 2005. Of these, 80 patients had solitary, 43 had unilobar multiple, and 77 had bilobar metastases. Prognostic factors of the 77 bilobar metastases were evaluated using multivariate analysis. The survival was compared with that of 95 patients undergoing chemotherapy for unresectable bilobar hepatic metastases. Univariate and multivariate analyses revealed that the number of metastasis (≥6) [relative risk (RR), 2.7; P = 0.002] and depth of invasion (T4) (RR, 2.0; P = 0.04) were predictors of survival of the 77 patients. The survival of 11 T4 cancer patients with six or more metastases was poor, but significantly better than that of 95 patients with unresectable bilobar metastases (P = 0.04). Surgical resection in stage IV colorectal cancer patients having bilobar hepatic metastases was justified in the present setting.

Clinicopathological features and outcome in advanced colorectal cancer patients with synchronous vs metachronous metastases

Background:Synchronous metastases of colorectal cancer (CRC) are considered to be of worse prognostic value compared with metachronous metastases, but only few and conflicting data have been reported on this issue.Methods:We retrospectively investigated patient demographics, primary tumour characteristics and overall survival (OS) in 550 advanced CRC patients with metachronous vs synchronous metastases, who participated in the phase III CAIRO study. For this purpose only patients with a prior resection of the primary tumour were considered.Results:The clinical and pathological characteristics associated with poor prognosis that we observed more often in patients with synchronous metastases (n=280) concerned an abnormal serum lactate dehydrogenase (LDH) concentration (P=0.01), a worse WHO performance status (P=0.02), primary tumour localisation in the colon (P=0.002) and a higher T stage (P=0.0006). No significant difference in median OS was observed between patients with synchronous metastases and metachronous metastases (17.6 vs 18.5 months, respectively, P=0.24).Conclusion:Despite unfavourable clinicopathological features in patients with synchronous metastases with a resected primary tumour compared to patients with metachronous metastases, no difference in the median OS was observed. Possible explanations include a (partial) chemoresistance in patients with metachronous disease because of previous adjuvant treatment, whereas differences between the two groups in screening procedures resulting in a lead time bias to diagnosis or in prognostic molecular markers remain speculative.

W1670 Treatment Strategy for Synchronous Metastases of Colorectal Cancer: Is Hepatic Resection After An Observation Interval Appropriate?

W1670 Treatment Strategy for Synchronous Metastases of Colorectal Cancer: Is Hepatic Resection After An Observation Interval Appropriate?

Treatment strategy for synchronous metastases of colorectal cancer: is hepatic resection after an observation interval appropriate?

In cases of synchronous colorectal hepatic metastases, the primary colorectal cancer strongly influences on the metastases. Our treatment policy has been to conduct hepatic resection for the metastases at an interval of 3 months after colorectal resection. We examined the appropriateness of interval hepatic resection for synchronous hepatic metastasis. The subjects were 164 patients who underwent resection of hepatic metastasis of colorectal cancer (synchronous, 70 patients; metachronous, 94 patients). Background factors for hepatic metastasis and postoperative results were compared for synchronous and metachronous cases. The cumulative survival rate for 164 patients at 3, 5, and 10 years postoperatively was 71.9%, 51.8%, and 36.6%, and the post-resection recurrence rate in remnant livers was 26.8%. Interval resection for synchronous hepatic metastases was conducted in 49 cases after a mean interval of 131 days. No difference was seen in postoperative outcome between synchronous and metachronous cases. The outcome was similarly favorable in cases of synchronous hepatic metastasis and in cases of metachronous metastasis. Delaying resection allows accurate understanding of the number and location of hepatic metastases, and is beneficial in determining candidates for surgery and in selecting surgical procedure.

Timing of Resection of Liver Metastases Synchronous to Colorectal Tumor: Proposal of Prognosis-Based Decisional Model

Timing of hepatectomy for synchronous metastases of colorectal cancer is still debated. The aim of this retrospective study was to analyze prognostic factors after synchronous and delayed liver resections to define selection criteria for choosing timing of hepatectomy. The study was performed on 127 patients with synchronous metastases undergoing radical hepatectomy. We divided patients according to the timing of hepatectomy: 70 synchronous (group A) and 57 delayed (group B). Overall survival was similar between the two groups (5-year survival 30.8% vs. 32.0% A vs. B, P = .406). The multivariate analysis evidenced four independent prognostic factors in group A: male sex (P = .04), T4 (P = .0035), more than three metastases (P = .0001), and metastatic infiltration of nearby structures (P < .0001). There were no statistically significant prognostic factors in group B. Patients with more than three metastases had a significantly worse survival in group A than in group B (3-year survival, 15.0% vs. 34.3%, P = .007); similarly, borderline significant difference was encountered in patients with T4 primary tumor (3-year survival, 16.7% vs. 60%, P = .064) Patients with liver metastases synchronous with colorectal cancer with T4 primary tumor, metastasis infiltration of neighboring structures, and especially with more than three metastases should receive neoadjuvant chemotherapy before liver resection.