Surgical Treatment of Colorectal Liver Metastases (eBook)

Title Page 2
Copyright Page 3
Foreword 4
Foreword 5
Preface 7
Table of Contents 9
Contributors 12
1 Epidemiology and Natural History 14
1.1 Introduction 14
1.2 Epidemiology 15
1.3 Natural History and Disease Therapy 17
References 19
2 Diagnosis and Staging 20
2.1 Introduction 20
2.2 Ultrasonography 21
2.2.1 Technique 21
2.2.2 Imaging Findings 22
2.3 Computed Tomography 23
2.3.1 Technique 23
2.3.2 Imaging Findings 25
2.4 Magnetic Resonance Imaging 26
2.4.1 Technique 26
2.4.2 Imaging Findings 28
2.5 Performance and Comparison of Imaging Modalities 29
2.6 Positron Emission Tomography 32
2.7 Diagnosis and Staging of Liver Metastases from Colorectal Cancer 35
2.8 Liver Metastases Detection After Chemotherapy 36
References 37
3 Evolution of Resectability Criteria 40
3.1 Introduction 40
3.2 Resectability Criteria 41
3.3 Resection Margin 44
References 45
4 Surgical Strategy 47
4.1 Introduction 47
4.2 Intraoperative Ultrasonography 48
4.2.1 Technique 48
4.2.2 Ultrasonographic Characteristics of Colorectal Liver Metastases 49
4.2.3 Intraoperative Staging 52
4.2.4 IOUS and Liver Resection 52
4.3 Parenchyma-sparing Surgery 55
4.4 Laparoscopic Liver Resection 57
4.4.1 Feasibility and Safety 58
4.4.2 Oncological Results 59
4.5 Hepatic Pedicle Clamping 60
4.5.1 Strategies To Reduce Reperfusion Injuries 60
4.5.2 Impact of Hepatic Pedicle Clamping on Long-term Outcome 61
References 62
5 Results of Surgery and Prognostic Factors 66
5.1 Introduction 66
5.2 Short-term Results 67
5.3 Long-term Results 69
5.3.1 Survival 69
5.3.2 Recurrence 71
5.4 Prognostic Factors 72
5.4.1 Traditional Prognostic Factors 72
5.4.2 Scoring Systems 77
5.4.3 Other Prognostic Factors 79
5.4.3.1 Clinical and Pathologic Prognostic Factors 79
5.4.3.2 Molecular Markers 81
References 82
6 Preoperative Chemotherapy 86
6.1 Introduction 86
6.2 Unresectable Liver Metastases 87
6.2.1 Conventional Chemotherapy 87
6.2.2 The Role of Targeted Therapies 89
6.2.3 Intra-arterial Chemotherapy 93
6.2.4 Secondary Resectability Rates and Timing of Surgery 93
6.2.5 Results of Surgery in Patients with Secondary Resectable Disease 95
6.3 Resectable Liver Metastases 96
6.3.1 Rationale 96
6.3.2 Results 97
6.3.3 Strategy Proposal 99
6.4 Chemotherapy-related Liver Injuries 100
6.4.1 Chemotherapy and Steatosis 101
6.4.2 Irinotecan and Steatohepatitis 102
6.4.3 Oxaliplatin and Sinusoidal Dilation 102
6.4.4 Bevacizumab 104
6.4.5 Cetuximab 105
6.5 Disappeared Liver Metastases 105
References 107
7 Synchronous Colorectal Liver Metastases 112
7.1 Introduction 112
7.2 Resectable Synchronous Liver Metastases 113
7.2.1 Technical Issues 114
7.2.2 Oncologic Issues 119
7.2.2.1 Time Test 119
7.2.2.2 Neoadjuvant Chemotherapy 120
7.2.2.3 Neoadjuvant Radiotherapy/Radiochemotherapy 121
7.3 Unresectable Synchronous Liver Metastases 121
7.3.1 Symptomatic Primary Tumor 123
7.3.2 Asymptomatic Primary Tumor 124
7.4 Conclusions 126
References 127
8 Therapeutic Strategies in Unresectable Colorectal Liver Metastases 131
8.1 Introduction 131
8.2 Portal Vein Occlusion 132
8.2.1 Indications 132
8.2.2 Techniques of Portal Vein Occlusion 132
8.2.3 Future Liver Remnant Hypertrophy After PVE 134
8.2.4 Chemotherapy and Hypertrophy 134
8.2.5 Early Outcomes of Hepatectomies Following PVE 135
8.2.6 Long-term Results 135
8.3 Two-stage Hepatectomy 136
8.3.1 Strategies 136
8.3.2 Short- and Long-term Results 138
8.4 Interstitial Treatments 140
8.4.1 Interstitial Treatments Associated with Liver Resection 140
8.4.2 Interstitial Treatments Alone 142
8.4.2.1 Radiofrequency Ablation 142
8.4.2.2 Microwave Ablation 143
8.4.2.3 Cryoablation 144
References 145
9 Extrahepatic Disease 148
9.1 Introduction 148
9.2 Lymph-node Metastases 149
9.3 Peritoneal Carcinomatosis 152
9.4 Pulmonary Metastases 154
9.5 Other Sites 156
9.5.1 Locoregional Recurrence 156
9.5.2 Adrenal Metastases 156
9.5.3 Bone and Brain Metastases 157
9.6 Conclusions 157
References 158
10 Adjuvant Chemotherapy and Follow-Up 161
10.1 Introduction 161
10.2 Adjuvant Chemotherapy 162
10.3 Follow-Up 163
References 164
11 Re-resection: Indications and Results 167
11.1 Introduction 167
11.2 Short-term Outcome 168
11.3 Long-term Outcome 169
References 170
12 LiverMetSurvey Registry: the Italian Experience 172
12.1 Introduction 172
12.2 The Italian Experience 174
12.2.1 Patient Characteristics 174
12.2.2 Short-term Outcomes 178
12.2.3 Long-term Outcomes 179
12.2.4 Prognostic Factors 180
12.2.5 Patients with Initially Unresectable Disease 185
12.2.6 Comparison with the LiverMetSurvey Series 186
12.2.7 Commentary 187
12.3 Conclusions 189
Subject Index 190