Current management of colorectal hepatic metastasis.

Department of Surgery, Division of Surgical Oncology, The Johns Hopkins 600 North Wolfe Street, Halsted 614, Baltimore, MD 21287, USA.
Expert review of gastroenterology & hepatology (Impact Factor: 2.55). 05/2009; 3(2):131-44. DOI: 10.1586/egh.09.8
Source: PubMed

ABSTRACT In the USA, cancers of the colon and rectum are the third most common site of new cancer cases and cancer deaths. With improved screening and adjuvant therapy, the survival of patients has increased substantially over the last decade. However, patients with metastatic disease often have limited survival. Hepatic metastasis is one of the most frequent sites of metastatic disease. In fact, 35-55% of patients with colorectal cancer will develop hepatic metastasis at some time during the course of their disease. Patients who are able to undergo complete resection of their hepatic metastases have the best chance of long-term survival. The goal of hepatic resection is to achieve complete resection of all metastases with microscopically negative surgical margins while preserving sufficient hepatic parenchyma. Survival following hepatic resection of colorectal metastasis now approaches 35-50%. However, approximately 65% of patients will have a recurrence at 5 years. Increasingly chemotherapeutic agents are being offered in the preoperative setting prior to operation. At the time of operation, patients with extensive hepatic disease can sometimes be offered ablative therapies combined with resection or staged approaches. Modern management of hepatic colorectal metastases necessitates a multidisciplinary approach to effectively treat these patients and increase the number of patients who will benefit from resection.

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    ABSTRACT: Following curative intent surgery (CIS) for colorectal liver metastasis (CRLM), patterns of recurrence and subsequent survival outcomes are not widely reported.
    Journal of Surgical Oncology 12/2014; 110(8). DOI:10.1002/jso.23756 · 2.84 Impact Factor
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    ABSTRACT: Introduction Following curative intent surgery (CIS) for colorectal liver metastasis (CRLM), repeat CIS for recurrence improves survival. The factors associated with repeat CIS are not widely reported. Methods An institutional database (January 2002-December 2012) was reviewed to evaluate factors influencing repeat CIS. Results One hundred sixty-three patients with colorectal liver metastasis (CRLM) underwent successful CIS. Median follow-up and disease-free interval (DFI) was 33 and 16 months, respectively. After initial CIS, 102 patients (63 %) recurred. Fifty-three patients (52 %) underwent a repeat CIS. After repeat CIS, 33 patients (62 %) developed a second recurrence, and in 13 patients (39 %), a third CIS was possible. DFI decreased following initial CIS (first CIS vs. second CIS vs. third CIS [20 vs. 15 vs. 8.5 months], p<0.001). Overall 5-year survival in all patients was 55 %; patients who recurred had a 5-year survival of 67 % if they underwent repeat CIS vs. 7.8 % if they were managed palliatively. Second CIS was less likely with a postoperative complication, other/multifocal recurrence, or DFI <12 months. Conclusion Despite high recurrence and decreasing DFI, repeat CIS provides a survival benefit. Postoperative complications, DFI, number, and pattern of recurrence influence the decision to pursue repeat CIS.
    Gastroenterology 06/2014; 18(11). DOI:10.1007/s11605-014-2580-7 · 13.93 Impact Factor
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    PLoS ONE 09/2014; 9(9):e107470. DOI:10.1371/journal.pone.0107470 · 3.53 Impact Factor