Speciality
Spotlight

 




 


Gastroenterologist


     

 





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.

        

 



 

 

Speciality Spotlight

 

 
Gastroenterologist
     

 

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.
        

 

 

By |2022-07-20T16:43:29+00:00July 20, 2022|Uncategorized|Comments Off on Colon Cancer

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