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Strategies for Surgical Treatment of Colorectal Liver Metastases
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Strategies for Surgical Treatment of Colorectal Liver Metastases

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (15 May 2022) | Viewed by 10754

Special Issue Editors

Prof. Dr. Alessandro Anselmo

E-Mail Website
Guest Editor
HPB Surgery and Transplantation Unit, Tor Vergata University, Policlinico Tor Vergata, Viale Oxford, 8-00133 Rome, Italy
Interests: liver surgery; liver and kidney transplantation; minimally invasive liver surgery; robotic surgery; immunosuppression; surgical oncology; hepatocellular carcinoma (Hcc); cholangiocellular carcinoma (Ccc); colorectal liver metastases (Crlm)
Dr. Benedetto Ielpo

E-Mail Website
Guest Editor
HPB Surgery Unit, Parc Salut Mar University Hospital, Passeig Marítim, 25-29-08003 Barcelona, Spain
Interests: liver surgery; minimally invasive liver surgery; surgical oncology; hepatocellular carcinoma (Hcc); cholangiocellular carcinoma (Ccc); colorectal liver metastases (Crlm)

Special Issue Information

Dear Colleagues, 

It is our pleasure to announce the launch of a new Special Issue of Healthcare on “Strategies for Surgical Treatment of Colorectal Liver Metastases”. Colorectal cancer is the second most common cancer among women and the third most common among men. It accounts for 10% of all cancer-related deaths globally, and about 25%–50% of patients develop colonic liver metastases (CRLMs). The survival rate following diagnosis has improved significantly over the years due to the multidisciplinary treatment that involves radiology, oncology, liver surgery, colorectal surgery, histopathology, and specialist nursing. This Special Issue will focus on the different surgical options for the treatment of synchronous or metachronous CRLMs, which include parenchyma-sparing liver resections; minimally invasive surgery; the so called “liver-first approach”; two-staged hepatectomy; ALLPS; and more recently, liver transplantation. Ablation techniques will also be addressed in this publication, as they play a role in the multimodal treatment of CRLMs. We look forward to receiving your abstracts on these topics. A webinar involving the best experts in this field will be held on 18 November 2021 at 3 pm CET. The program of this event and a link for free registration is provided here.

text

Prof. Dr. Alessandro Anselmo
Dr. Benedetto Ielpo
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • colorectal liver metastases
  • colon cancer
  • liver surgery
  • liver transplantation
  • minimally invasive liver surgery
  • adjuvant chemotherapy
  • laparoscopy
  • liver resection
  • ALLPS
  • two-stage hepatectomy

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Published Papers (5 papers)

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Research

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14 pages, 1725 KiB  
Article
A Comparison between Open and Minimally Invasive Techniques for the Resection of Colorectal Liver Metastasis
by Ilenia Bartolini, Laura Fortuna, Matteo Risaliti, Luca Tirloni, Simone Buccianti, Cristina Luceri, Maria Novella Ringressi, Giacomo Batignani and Antonio Taddei
Healthcare 2022, 10(12), 2433; https://doi.org/10.3390/healthcare10122433 - 2 Dec 2022
Cited by 1 | Viewed by 1412
Abstract
The liver is the most common site of colorectal cancer metastasis. Liver surgery is a cornerstone in treatment, with progressive expansion of minimally invasive surgery (MIS). This study aims to compare short- and long-term outcomes of open surgery and MIS for the treatment [...] Read more.
The liver is the most common site of colorectal cancer metastasis. Liver surgery is a cornerstone in treatment, with progressive expansion of minimally invasive surgery (MIS). This study aims to compare short- and long-term outcomes of open surgery and MIS for the treatment of colorectal adenocarcinoma liver metastasis during the first three years of increasing caseload and implementation of MIS use in liver surgery. All patients treated between November 2018 and August 2021 at Careggi Teaching Hospital in Florence, Italy, were prospectively entered into a database and retrospectively reviewed. Fifty-one patients were resected (41 open, 10 MIS). Considering that patients with a significantly higher number of lesions underwent open surgery and operative results were similar, postoperative morbidity rate and length of hospital stay were significantly higher in the open group. No differences were found in the pathological specimen. The postoperative mortality rate was 2%. Mean overall survival and disease-free survival were 46 months (95% CI 42–50) and 22 months (95% CI 15.6–29), respectively. The use of minimally invasive techniques in liver surgery is safe and feasible if surgeons have adequate expertise. MIS and parenchymal sparing resections should be preferred whenever technically feasible. Full article
(This article belongs to the Special Issue Strategies for Surgical Treatment of Colorectal Liver Metastases)
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15 pages, 815 KiB  
Article
The Impact of Postoperative Complications on Survival after Simultaneous Resection of Colorectal Cancer and Liver Metastases
by Sorin Tiberiu Alexandrescu, Narcis Octavian Zarnescu, Andrei Sebastian Diaconescu, Dana Tomescu, Gabriela Droc, Doina Hrehoret, Vladislav Brasoveanu and Irinel Popescu
Healthcare 2022, 10(8), 1573; https://doi.org/10.3390/healthcare10081573 - 19 Aug 2022
Viewed by 1689
Abstract
Background: The aim of this study was to investigate the impact of postoperative complications on the long-term outcomes of patients who had undergone simultaneous resection (SR) of colorectal cancer and synchronous liver metastases (SCLMs). Methods: We conducted a single-institution survival cohort study in [...] Read more.
Background: The aim of this study was to investigate the impact of postoperative complications on the long-term outcomes of patients who had undergone simultaneous resection (SR) of colorectal cancer and synchronous liver metastases (SCLMs). Methods: We conducted a single-institution survival cohort study in patients with SR, collecting clinical, pathological, and postoperative complication data. The impact of these variables on overall survival (OS) and disease-free survival (DFS) was compared by log rank test. Multivariate Cox regression analysis identified independent prognostic factors. Results: Out of 243 patients, 122 (50.2%) developed postoperative complications: 54 (22.2%) major complications (Clavien–Dindo grade III–V), 86 (35.3%) septic complications, 59 (24.2%) hepatic complications. Median comprehensive complication index (CCI) was 8.70. Twelve (4.9%) patients died postoperatively. The 3- and 5-year OS and DFS rates were 60.7%, 39.5% and 28%, 21.5%, respectively. Neither overall postoperative complications nor major and septic complications or CCI had a significant impact on OS or DFS. Multivariate analysis identified the N2 stage as an independent prognostic of poor OS, while N2 stage and four or more SCLMs were independent predictors for poor DFS. Conclusion: N2 stage and four or more SCLMs impacted OS and/or DFS, while CCI, presence, type, or grade of postoperative complications had no significant impact on long-term outcomes. Full article
(This article belongs to the Special Issue Strategies for Surgical Treatment of Colorectal Liver Metastases)
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11 pages, 2667 KiB  
Article
KRAS Assessment Following ESMO Recommendations for Colorectal Liver Metastases. Is It Always Worth It?
by Olga Morató, Maria Villamonte, Patricia Sánchez-Velázquez, Eva Pueyo-Périz, Luís Grande, Benedetto Ielpo, Edoardo Rosso, Alessandro Anselmo and Fernando Burdío
Healthcare 2022, 10(3), 472; https://doi.org/10.3390/healthcare10030472 - 3 Mar 2022
Cited by 1 | Viewed by 2436
Abstract
Background: Genetic evaluation is essential in assessing colorectal cancer (CRC) and colorectal liver metastasis (CRLM). The aim of this study was to determine the pragmatic value of KRAS on oncological outcomes after CRLM according to the ESMO recommendations and to query whether it [...] Read more.
Background: Genetic evaluation is essential in assessing colorectal cancer (CRC) and colorectal liver metastasis (CRLM). The aim of this study was to determine the pragmatic value of KRAS on oncological outcomes after CRLM according to the ESMO recommendations and to query whether it is necessary to request KRAS testing in each situation. Methods: A retrospective cohort of 126 patients who underwent surgery for hepatic resection for CRLM between 2009 and 2020 were reviewed. The patients were divided into three categories: wild-type KRAS, mutated KRAS and impractical KRAS according to their oncological variables. The impractical (not tested) KRAS group included patients with metachronous tumours and negative lymph nodes harvested. Disease-free survival (DFS), overall survival (OS) and hepatic recurrence-free survival (HRFS) were calculated by the Kaplan–Meier method, and a multivariable analysis was conducted using the Cox proportional hazards regression model. Results: Of the 108 patients identified, 35 cases had KRAS wild-type, 50 cases had a KRAS mutation and the remaining 23 were classified as impractical KRAS. Significantly longer medians for OS, HRFS and DFS were found in the impractical KRAS group. In the multivariable analyses, the KRAS mutational gene was the only variable that was maintained through OS, HRFS and DFS. For HRFS (HR: 13.63; 95% confidence interval (CI): 1.35–100.62; p = 0.010 for KRAS), for DFS (HR: 10.06; 95% CI: 2.40–42.17; p = 0.002 for KRAS) and for OS (HR: 4.55%; 95% CI: 1.37–15.10; p = 0.013). Conclusion: Our study considers the possibility of unnecessary KRAS testing in patients with metachronous tumours and negative lymph nodes harvested. Combining the genetic mutational profile (i.e., KRAS in specific cases) with tumour characteristics helps patient selection and achieves the best prognosis after CRLM resection. Full article
(This article belongs to the Special Issue Strategies for Surgical Treatment of Colorectal Liver Metastases)
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Review

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13 pages, 792 KiB  
Review
Disappearing Colorectal Liver Metastases: Do We Really Need a Ghostbuster?
by Alessandro Anselmo, Chiara Cascone, Leandro Siragusa, Bruno Sensi, Marco Materazzo, Camilla Riccetti, Giulia Bacchiocchi, Benedetto Ielpo, Edoardo Rosso and Giuseppe Tisone
Healthcare 2022, 10(10), 1898; https://doi.org/10.3390/healthcare10101898 - 28 Sep 2022
Cited by 5 | Viewed by 2223
Abstract
The development of new systemic treatment strategies has resulted in a significant increase in the response rates of colorectal liver metastases (CRLM) in the last few years. Although the radiological response is a favorable prognostic factor, complete shrinkage of CRLM, known as disappearing [...] Read more.
The development of new systemic treatment strategies has resulted in a significant increase in the response rates of colorectal liver metastases (CRLM) in the last few years. Although the radiological response is a favorable prognostic factor, complete shrinkage of CRLM, known as disappearing liver metastases (DLM), presents a therapeutic dilemma, and proper management is still debated in the literature. In fact, DLM is not necessarily equal to cure, and when resected, pathological examination reveals in more than 80% of patients a variable percentage of the tumor as residual disease or early recurrence in situ. Moreover, while a higher incidence of intrahepatic recurrence is documented in small series when surgery is avoided, its clinical significance for long-term OS is still under investigation. In light of this, a multidisciplinary approach and, in particular, radiologists’ role is needed to assist the surgeon in the management of DLM, thanks to emerging technology and strategy. Therefore, the aim of this review is to provide an overview of the DLM phenomenon and current management. Full article
(This article belongs to the Special Issue Strategies for Surgical Treatment of Colorectal Liver Metastases)
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Other

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6 pages, 2431 KiB  
Case Report
Laparoscopic Resection of Synchronous Liver Metastasis Involving the Left Hepatic Vein and the Common Trunk Bifurcation: A Strategy of Parenchyma-Sparing Resection with Left Sectionectomy and 4a Subsegmentectomy by Arantius Approach
by Filippo Banchini, Enrico Luzietti, Gerardo Palmieri, Deborah Bonfili, Andrea Romboli, Luigi Conti and Patrizio Capelli
Healthcare 2022, 10(3), 517; https://doi.org/10.3390/healthcare10030517 - 11 Mar 2022
Cited by 3 | Viewed by 2098
Abstract
When colorectal cancer presents with liver metastasis, hepatic resection remains the most important factor in prolonging survival, and new paradigms have been proposed to augment resectability. An adequate liver remnant and vascularisation are the only limits in complex liver resection, and parenchyma-sparing surgery [...] Read more.
When colorectal cancer presents with liver metastasis, hepatic resection remains the most important factor in prolonging survival, and new paradigms have been proposed to augment resectability. An adequate liver remnant and vascularisation are the only limits in complex liver resection, and parenchyma-sparing surgery is a strategy for minimising the complications, preserving liver function, and allowing patients to undergo further liver resection. The laparoscopic approach represents a new challenge, especially when lesions are located in the superior or posterior part of the liver. We discuss the case of an 81-year-old patient with a single synchronous liver metastasis involving the left hepatic vein and leaning into the middle hepatic vein at the common trunk, where we performed a simultaneous laparoscopic colonic resection with a left sectionectomy extended to segment 4a. The strategic approach to the Arantius ligament by joining the left and middle hepatic vein allowed us to avoid a major liver hepatectomy, preserve the liver parenchyma, reduce complications, enhance patient recovery, and perform the entire procedure by laparoscopy. Our example suggests that the Arantius approach to the left hepatic vein and the common trunk could be a feasible approach to consider in laparoscopic surgery for lesions located in their proximity. Full article
(This article belongs to the Special Issue Strategies for Surgical Treatment of Colorectal Liver Metastases)
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