Colon cancer with liver metastasis

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Colon cancer with liver metastasis

• Reported by Ri ???
• May 3 ,2004

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Colon cancer

• Familial(15)
• -Familial adenomatous polyposis(1)
• -HNPCC(14)
• Sporadic(85)

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Treatment

• Surgery
• Curative resection en bloc(safety margin25cm )
• with the adequate margins and removals of the
  regional lymph nodes.

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Technique of right hemicolectomy.
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Technique of extended right hemicolectomy.
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Technique of left hemicolectomy.
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Adjuvent chemotherapy

• 5-FU levamisole(or leucovorin)
• Therapy with 5-FU and levamisole reduced the risk
  of cancer recurrence by 39 .
• No survival benefit in patients with Stage II
  disease who received chemotherapy.
• Improved survival rates in patients with Stage
  III colon cancer.

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Colon cancer with liver metastasis

• From Hematology/oncology Clinics of North America
  ,August 2002

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Colon cancer with liver metastasis (1)

• Surgical resection of colorectal liver metastases
  offers the best outcome - if disease is confined
  to a resectable portion of the liver.
• No other therapy can approach the 25 to 35
  5-year survival rate that has been demonstrated
  in multiple studies - From Fong Y. Surgical
  therapy of hepatic colorectal metastasis. CA
  Cancer J Clin 199949231-55
• Unresectable because of number of lesions
  ,proximity to major vascular structure or
  advanced preexisting liver disease.

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Colon cancer with liver metastasis(2)

• Even patients who have previously undergone
  hepatic resection for colorectal liver metastasis
  benefit from repeat resection if it is
  technically possible.
• A recent series of 64 patients reported a 41
  5-year survival rate for this subset of patients.
• -Repeat hepatectomy for colorectal liver
  metastasis ,Ann Surg 1997

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Colon cancer with liver metastasis(3)

• For these reasons, unless there is an absolute
  prohibitive medical risk, all patients with
  potentially resectable liver careful evaluation
  to determine whether they have potentially
  resectable disease .

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Preoperative evaluation of colon cancer patients
with liver disease

• Similar to that for patients with primary
  colorectal tumors, with the exception of specific
  hepatic cross-sectional and nuclear imaging.
• Although CT is sensitive for identifying liver
  lesions, its specificity for distinguishing
  benign from malignant lesions is less accurate.

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Preoperative evaluation of colon cancer patients
with liver disease

• In contrast, MRI is sensitive and specific for
  malignant hepatic lesions
• MRI is the study of choice in evaluating
  potentially metastatic colorectal cancer.
• In addition, MRI provides valuable information on
  the relationship between liver lesions and the
  hepatic vasculature, which becomes important in
  the technical aspects of liver resection.

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Preoperative evaluation of colon cancer patients
with liver disease

• Before surgery - it is necessary to evaluate for
  extrahepatic disease because its presence
  significantly changes the management strategy.
• PET is a valuable adjunct in the radiologic
  evaluation of potential candidates for liver
  resection.

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Preoperative evaluation of colon cancer patients
with liver disease

• PET technology is based on the observation that
  malignant cells have a higher affinity for
  glucose, so the active compound used is a
  radioactive glucose analogue.
• Several studies have shown PET scanning to be
  the most sensitive modality for detecting
  extrahepatic metastases
• -Positron emission tomography imaging of
  colorectal cancer. Semin Oncol 199926577-83

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Ablative therapies

• For patients in whom resection is not possible,
  other regionally directed modalities have been
  used, including cryoablation, RFA(radiofrequency
  ablation), HAT pump (Hepatic artery infusion)
  placement, and isolated hepatic perfusion.

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Ablative therapies

• In cryotherapy, the ablation of liver tumors is
• - based on the cytotoxic effects of multiple
  freezethaw cycles.
• A probe is inserted into the lesions with
  ultrasound guidance - treated until they obtain a
  characteristic homogenous appearance on
  ultrasound.
• Retrospective analysis of cryotherapy with or
  without resection of all liver lesions - reported
  a median survival of 26 to 30 months .

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Regional chemotherapy

• Liver-directed chemotherapy through a hepatic
  artery infusion pump was initially used in the
  1970s and 1980s.
• Deliver higher doses of agents directly to the
  target tissue while minimizing systemic toxicity.

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Regional chemotherapy

• Metastatic tumor deposits within the liver derive
  their blood supply from branches of the hepatic
  artery.
• Intraarterial chemotherapy would more selectively
  target tumors while sparing normal liver tissue.
• Preoperative visceral angiogram because only two
  thirds of patients have conventional vascular
  anatomy.

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Can it be resected simultaneous?

• -From Journal of the American College of Surgeons
  01-AUG-2003

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Can it be resected simultaneous?

• 240 pts, primary large bowel adenocarcinoma with
  liver metastasis(19842001)
• 134 pts s/p simultaneous resection of colon
  cancer and liver metastasis(Group.1),and 106 pts
  s/p staged operation(Group.2)

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Can it be resected simultaneous?

• Simultaneous resection group
• -more Rt colon primary(plt0.001)
  ,smaller(plt0.01)
• -fewer numbers of liver metastasis(plt0.001)
• -less extensive liver resection(plt0.001)
• -Less complication(49 v.s 67)(plt0.003)
• -Less hospitalization days (10days
  v.s.18days) (p0.001)
• -Perioperative mortalitySimilar(n3v.s.n3)

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Conclusion

• Simultaneous colon and liver resection is safe
  and efficient
• Overall complication rate and morbidity rate is
  reduced, but no change in operative mortality

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Thanks for your attention!