Colon Cancer

Colon
Cancer

  

• Jean-Christophe
  Vaillant, B Nordinger, S.Deuffic, Jean-Pierre Arnaud, et
  al (Chirurgie digestive et Oncologique, Hopital Ambroise
  Pare, France)
  
  Adjuvant Intraperitoneal 5-Fluorouracil in High-Risk Colon Cancer.
  
  A Multicenter Phase III Trial.
  
  Annals
  of Surgery, April 2000; 
  231(4), 449-456
  
   
  
  
  Patients
  with stage II and III colon cancers are considered at
  risk of tumor recurrence in the liver and the
  peritoneum. Systemic
  adjuvant chemotherapy improves the survival for 6
  months. It was
  therefore decided to conduct a study of the effect of
  locoregional chemotherapy on tumor recurrence.
  
   
  
  Despite
  promising initial results, adjuvant intraportal
  chemotherapy produced controversial and very limited
  results. Therefore,
  adjuvant intraperitoneal chemotherapy was tried to add a
  local affect on the peritoneum as well as the liver.
  
   
  
  The
  study was conducted on 267 patients randomly divided
  into 2 equal groups. One
  group was operated followed by intraperitoneal
  administration of 5-FU for 6 days and intraoperative
  intravenous chemotherapy.
  The other group underwent resection only.
  
   
  
  The
  results showed an overall 5 year survival of 74% in
  Group 1, and 69% in Group 2.
  Disease free survival rates were 68% and 62%
  respectively. Survival curves were superimposed for first three years and began
  diverging thereafter.
  
   
  
  They
  conclude that intraperitoneal and short systemic
  intravenous chemotherapy after surgery may not be
  sufficient to reduce the risk of death but it reduced
  the risk of recurrence.
  
       

• J.Peter
  Lodge, Basil J.Ammori, K.Rajendra Prasad and M.C.
  Bellamy (The Centre for Hepatobiliary Diseases and the
  Department of Anaesthesia, St.James’s University
  Hospital, Leeds, UK)
  
  Ex-Vivo
  and In Situ Resection of Inferior Vena Cava with
  Hepatectomy for Colorectal Metastases.
  
  Annals of Surgery, April 2000; 231(4), 471-479.
  
    
  
  
  Untreated
  patients with hepatic metastases from colorectal cancer
  have a poor prognosis with a median survival of less
  than 1 year. Chemotherapy
  may have a beneficial effect on the natural history of
  the unresected hepatic metastases but 5 year survivals
  are few and far between hepatic resection can achieve
  prolonged survival (25% – 50%) with a mortality rate of
  about 5%.
  
    
  
  Involvement
  of the IVC by hepatic tumours is considered inoperable.
  This study undertook concomitant hepatic and IVC
  resection to achieve adequate tumour clearance.
  
    
  
  158
  patients were subjected to hepatic resection surgery in
  a single unit. Eight
  patients between the ages of 42 – 80 years underwent
  concomitant I.V.C resection along with four to six
  hepatic segments. Resections were carried out under total hepatic vascular occlusion
  in four patients and ex-vivo in four patients where the
  I.V.C was replaced by an autogenous vein patch a ringed
  Gore-Tex tube and a Dacron tube graft or patch or was
  repaired by primary suturing.
  
   
  
  There
  were two early deaths. One
  who died from renal cell carcinoma survived 30 months,
  and the fourth died in the recurrent disease at 9
  months.
  
    
  
  The
  four who survived, are alive from 5 to 12 months after
  surgery. Two of
  these were free from recurrence while two had
  recurrences.
  
    
  
  The
  authors conclude that this aggressive approach attendant
  with considerable surgical risk offers hope to advanced
  diseased patients who would otherwise have a dismal
  prognosis.
  
     

• Daniel Azoulay, Denis Castaing, Alloua Smail, et al (the Centre
  Hepato-Biliaire, Hopital Paul Brousse, Villejuif, et
  Universite Paris-Sud, Paris, France)
  
  Resection
  of Nonresectable Liver Metastases From Colorectal Cancer
  After Percutaneous Portal Vein Embolism.
  
  Annals of Surgery 231(4), 480-486.
  
    
  
  
  Curative
  liver resections of colorectal metastases is the only
  treatment offering a chance of long term survival (25% -
  50%) of 5 years. However,
  it can be performed only in 10% of cases.
  In order to enable resections in a larger number
  of cases, preoperative chemotherapy has been used to
  downstage the disease. When
  a tumour is very large, the contra-indication is from
  the paucity of the remnant liver segment leading to
  liver failure. For
  this group of patients, preoperative portal vein
  embolization (PVE) of the liver has been proposed to
  induce ipsilateral atrophy and contralateral hypertrophy
  of the remnant liver thus preventing liver failure.
  
    
  
  The
  aim of the study is to assess the influence of
  preoperative portal vein embolization on the long-term
  outcome of liver resection for colorectal metastases.
  
    
  
  30
  patients underwent PVE and 88 patients did not before
  resection of 4 or more liver segments.
  The groups were comparable in terms of sex, age,
  number and type of metastases (synchronous vs
  metachronous) and number of courses of neoadjuvant
  chemotherapy.
  
    
  
  The
  main criterion for PVE was that resection was
  technically feasible but contraindicated because the
  remnant liver was too small (as estimated by CT scan
  volumetry). It
  was done when the estimated rate of remnant functional
  liver parenchyma (ERRFLP) was 40% or less.
  
     
  
  PVE
  was feasible in all patients.
  There were no deaths with a complication rate of
  3%. The post
  ERRFLP was significantly increased as compared to pre
  PVE value. Liver resection was performed in 19 patients (63%) with a mortality
  of 4% and complication rate of 7%.
  The survival rates after hepatectomy in both
  groups were comparable.
  
    
  
  The
  authors conclude that PVE allows more patients with
  unresectable liver metastases to benefit from surgery.
  
        

• Masami
  Minagawa, Masatoshi Makuuchi, Guido Torzilli, et al (Department
  of Hepato-Biliary-Pancreatic Surgery, the Department of
  Artificial Organ and Transplantation, Graduate School of
  Medicine, Univ. of Tokyo, Japan; First Department of
  Surgery, shinshu University, Matsumoto, Japan; and the
  Department of Surgery, National Cancer Center, Tokyo,
  Japan)
  
  Extension
  of the Frontiers of Surgical Indications in the
  Treatment of Liver Metastases From 
  Colorectal Cancer.
  
  Long-Term Results:
  
  Annals of Surgery; 231(40, 487-499
  
    
  
  Two
  opposite trends can be recognised in the management of
  liver metastases from colorectal cancer (1) an
  aggressive policy that extends the indications for
  surgery and (2) a less invasive approach with broader
  indications for more conservative therapies such as
  interstitial treatment. This
  study retrospectively evaluates the long term results of
  our aggressive policy.
  
   
  
  235
  patients underwent hepatic resection for metastatic
  colorectal cancer. Survival
  rates and disease free survival as a function of
  clinical and pathological determinants were examined
  retrospectively with univariate and multivariate
  analyses.
  
   
  
  The
  overall 3, 5, 10 and 15 year survival rates were 51%,
  38%, 26% and 24% respectively.
  The stage of the primary tumour, lymph node
  metastases and multiple nodules were significantly
  associated with a poor prognosis in both univariate and
  multivariate analyses. Disease
  free survival was significantly influenced by lymph node
  metastases, a short interval between treatment of
  primary and metastatic tumours and a high preoperative
  level of CEA. The
  ten year survival rate of patients with 4 or more
  nodules (29%) was better than that of patients with two
  or three nodules (16%) and similar to that of patients
  with a solitary lesion (32%).
  
   
  
  The
  authors conclude that surgical resection is useful for
  treating liver metastases from colorectal cancer.
  Although multiple metastases significantly
  impaired that prognosis, the life expectancy of patients
  with four or more nodules mandates removal.
  
      

• Jean-Christophe
  Valliant, Barnard Nordinger, Sylvie deuffe, et al 
  (Chirurgie Digestive et Oncologique, Hopital
  Ambroise Pare, Boulogne Cedex France)
  
  Adjuvant Intraperitoneal 5-Fluorouracil in High-Risk Colon Cancer.
  
  A Multicenter Phase III Trial.
  
  Annals of Surgery, April 2000, 231(4), 449-456,
  
    
  
  
  Patients
  with stage II and III colon cancers are considered at
  risk of tumor recurrence in the liver and the
  peritoneum. Systemic
  adjuvant chemotherapy improves the survival for 6
  months. It was
  therefore decided, to conduct a study of the effect of
  locoregional chemotherapy on tumor recurrence.
  
    
  
  Despite promising initial results, adjuvant intraportal
  chemotherapy produced controversial and very limited
  results. Therefore,
  adjuvant intraperitoneal chemotherapy was tried to add a
  local affect on the peritoneum as well as the liver.
  
   
  
  The
  study was conducted on 267 patients randomly divided
  into 2 equal groups. One
  group was operated followed by intraperitoneal of 5-FU
  for 6 days and intraoperative intravenous chemotherapy.
  The other group underwent resection only.
  
   
  
  The
  results showed an overall 5 yr survival of 74% in Group
  1, and 69% in Group 2. Disease
  free survival rates were 68% and 62% respectively. Survival curves were superimposed for first three years and began
  diverging thereafter.
  
   
  
  They
  conclude that intraperitoneal and short systemic
  intravenous chemotherapy after surgery may not be
  sufficient to reduce the risk of death but it reduced
  the risk of recurrence.
  
      

• J
  Peter A Lodge, Basil J Ammori, et al (The Centre for
  Hepatobiliary Diseases and the Department of Anaesthesia,
  St. James’s University Hospital, Leeds, United Kingdom)
  
  Ex
  Vivo and In Situ Resection of Inferior Vena Cava with
  Hepatectomy for Colorectal Metastases.
  
  Annals of Surgery, April 2000, vol.231(4), 471-479.
  
   
  
  
  Untreated
  patients with hepatic metastases from colorectal cancer
  have a poor prognosis with a median survival of less
  than 1 year. Chemotherapy
  may have a beneficial effect on the natural history of
  the unresected hepatic metastases but 5 year survivals
  are few and far between.
  Hepatic resection can achieve prolonged survival
  (25% – 50%) with a mortality rate of about 5%.
  
    
  
  Involvement
  of the I.V.C by hepatic tumours is considered
  inoperable. This
  study undertook concomitant hepatic and I.V.C. resection
  to achieve adequate tumour clearance.
  
    
  
  158
  patients were subjected to hepatic resection 
  surgery in a single unit.
  Eight patients between the ages of 42-80 years
  underwent concomitant I.V.C resection along with four to
  six hepatic segments. Resections
  were carried out under total hepatic vascular occlusion
  in four patients and ex-vivo 
  in four patients where the I.V.C was replaced by
  an autogenous vein patch, a ringed Gore-tex tube and a dacron
  graft or patch or was repaired by primary suturing.
  
    
  
  There
  were 2 early deaths. One who died from renal cell carcinoma survived 30 months, and the
  fourth died with recurrent disease at 9 months.
  
   
  
  The
  four who survived, are alive from 5 to 12 months after
  surgery. Two of
  these were free from recurrence while two had
  recurrences.
  
   
  
  The
  authors conclude that this aggressive approach attendant
  with considerable surgical risk offers hope to advanced
  diseased patients who would otherwise have a dismal
  prognosis.
  
     

• Daniel
  Azoulay, Denis Castaing, Alloua Smail, et al (The Centre
  Hepato-Biliaire, Hopital Paul Brousse, Veillejuif, et
  Universite Paris-Sud, Paris, France)
  
  Resection
  of Nonresectable Liver Metastases From Colorectal Cancer
  after Percutaneous Portal Vein Embolization.
  
  Annals of Surgery, April 2000, 231(4), 480-486
  
   
  
  Curative
  liver resections of colorectal metastases is the only
  treatment offering a chance of long term survival (25% -
  50%) at 5 years. However,
  it can be performed only in 10% of cases.
  In order to enable resections in a larger number
  of cases, preoperative chemotherapy has been used to
  downstage the disease. When
  a tumour is very large, the contra-indication is from
  the paucity of the remnant liver segment leading to
  liver failure. For
  this group of patients, pre-operative portal vein
  embolization (PVE) of the liver has been proposed to
  induce ipsilateral atrophy and contralateral hypertrophy
  of the remnant liver thus preventing liver failure.
  
   
  
  The
  aim of this study is to assess the influence of
  preoperative portal vein embolization on the long-term
  outcome of liver resection for colorectal metastases.
  
   
  
  30
  patients underwent PVE and 88 patients did not before
  resection of 4 or more liver segments.
  The groups were comparable in terms of sex, age,
  number and type of metastases (synchronous vs
  metachronous) and number of courses of neoadjuvant
  chemotherapy.
  
   
  
  The
  main criterion for PVE was that resection was
  technically feasible but contraindicated because the
  remnant liver was too small (as estimated by CT scan
  volumetry). It
  was done when the estimated rate of remnant functional
  liver parenchyme (ERRFLP) was 40% or less.
  
   
  
  PVE
  was feasible in all patients.
  There were no deaths with a complication rate of
  3%. The post
  ERRFLP was significantly increased as compared to pre
  PVE value. Liver resection was performed in 19 patients (63%) with a mortality
  of 4% and complication rate of 7%.
  The survival rates after hepatectomy in both
  groups were comparable.
  
   
  
  The
  authors conclude that PVE allows more patients with
  unresectable liver metastases to benefit from surgery.
  
      

• Masami
  Minagawa, Masatoshi Makuuchi, Guido 
  Torzilli, et al (Department of Hepato-Biliary -
  Pancreatic Surgery, the Department of Artificial Organ
  and Transplantation. 
  Graduate School of Medicine, University of Tokyo,
  Japan, First Departent of Surgery, Shinshu Universtiy,
  Matsumoto Japan and the Department of Surgery,National
  Cancer Center, Tokyo, Japan)
  
  Extension
  of the Frontiers of Surgical Indications in the
  Treatment of liver metastases from Colorectal cancer-
  long term results.
  
  Annals of Surgery, April 2000, 231(4), 487-499.
  
  
  
  Two opposite trends can be recognised in the management
  of liver metastases from colorectal cancer (1) an
  aggressive policy that extends the indications for
  surgery and (2) a less invasive approach with broader
  indications for more conservative therapies such as
  interstitial treatment. This study retrospectively
  evaluates the long term results of our aggressive
  policy.
  
      
  
  235 patients underwent hepatic resection for metastatic
  colorectal cancer. Survival
  rates and disease free survival as a function of
  clinical and pathological determinants were examined
  retrospectively with univariate and multivariate
  analyses.
  
     
  
  The overall 3, 5, 10 and 15 year survival rates were
  51%, 38%, 26% and 24% respectively.
  The stage of the primary tumour, lymph node
  metastases and multiple nodules were significantly
  associated with a poor prognosis in both univariate and
  multivariate analyses. Disease
  free survival was significantly influenced by lymph node
  metastases, a short interval between treatment of
  primary and metastatic tumours and a high preoperative
  level of CEA. The
  ten year survival rate of patients with 4 or more
  nodules (29%) was better than that of patients with two
  or three nodules (16%) and similar to that of patients
  with a solitary lesion (32%).
  
      
  
  The authors conclude that surgical resection is useful
  for treating liver metastases from colorectal cancer.
  Although multiple metastases significantly
  impaired that prognosis, the life expectancy of patients
  with four or more nodules mandates removal.