Alice C Wei1,2,3, Natalie G Coburn4,5,6, Katharine S Devitt7, Pablo E Serrano8,9, Carol-Anne Moulton7,5, Sean P Cleary7,5, Calvin Law4,5,6, Malcolm J Moore10, Steven Gallinger7,5. 1. Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada. Alice.Wei@uhn.ca. 2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. Alice.Wei@uhn.ca. 3. Department of Surgery, University of Toronto, Toronto, Canada. Alice.Wei@uhn.ca. 4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. 5. Department of Surgery, University of Toronto, Toronto, Canada. 6. Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Canada. 7. Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada. 8. Hepatobiliary & Pancreatic Surgical Oncology, Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada. 9. Department of Surgery, McMaster University, Hamilton, Ontario, Canada. 10. BC Cancer Agency, Vancouver, British Columbia, Canada.
Abstract
PURPOSE: Metastasectomy for intrahepatic metastases (IHM) from colorectal cancer (CRC) provides excellent 5-year overall survival (OS). Presence of extrahepatic metastases (EHM) has been a historic contraindication to surgery. Due to improved safety of hepatectomy, there is growing interest in multisite metastasectomy for IHM and EHM. The objective of this study was to evaluate the results of metastasectomy for patients with IHM and EHM from CRC. METHODS: A phase II study of metastasectomy for both IHM and EHM from CRC. Eligible patients with any number of IHM and up to three EHM foci, resectable with RO intent, were offered metastasectomy. Clinical, survival, and quality of life (QoL) data were analyzed using standard statistical methods. RESULTS: Twenty-six patients were enrolled with a median age of 58 (range 32-84) years; 14/26 (54 %) presented with synchronous disease. The lung was the most common EHM site (13/26, 50 %). Protocol surgery was completed in 20/26 (77 %), including 12/26 (46 %) planned sequential resections. Major morbidity and perioperative mortality were 5/26 (19 %) and 1/26 (4 %), respectively. The QoL decline appeared to be transient. All QoL domains returned to baseline by 1-year posttreatment. The median recurrence-free survival (RFS) was 5 months by intent-to-treat analysis. The median OS from the time of CRC diagnosis and metastasectomy were 50 and 38 months (3-year OS 80 and 53 %), respectively. CONCLUSIONS: Complete metastasectomy of multisite CRC is safe, but disease recurs in the majority of patients. Data suggest that aggressive multisite metastasectomy may provide OS benefit for selected patients.
PURPOSE: Metastasectomy for intrahepatic metastases (IHM) from colorectal cancer (CRC) provides excellent 5-year overall survival (OS). Presence of extrahepatic metastases (EHM) has been a historic contraindication to surgery. Due to improved safety of hepatectomy, there is growing interest in multisite metastasectomy for IHM and EHM. The objective of this study was to evaluate the results of metastasectomy for patients with IHM and EHM from CRC. METHODS: A phase II study of metastasectomy for both IHM and EHM from CRC. Eligible patients with any number of IHM and up to three EHM foci, resectable with RO intent, were offered metastasectomy. Clinical, survival, and quality of life (QoL) data were analyzed using standard statistical methods. RESULTS: Twenty-six patients were enrolled with a median age of 58 (range 32-84) years; 14/26 (54 %) presented with synchronous disease. The lung was the most common EHM site (13/26, 50 %). Protocol surgery was completed in 20/26 (77 %), including 12/26 (46 %) planned sequential resections. Major morbidity and perioperative mortality were 5/26 (19 %) and 1/26 (4 %), respectively. The QoL decline appeared to be transient. All QoL domains returned to baseline by 1-year posttreatment. The median recurrence-free survival (RFS) was 5 months by intent-to-treat analysis. The median OS from the time of CRC diagnosis and metastasectomy were 50 and 38 months (3-year OS 80 and 53 %), respectively. CONCLUSIONS: Complete metastasectomy of multisite CRC is safe, but disease recurs in the majority of patients. Data suggest that aggressive multisite metastasectomy may provide OS benefit for selected patients.
Authors: Elske C Gootjes; Eric P van der Stok; Cornelis Verhoef; Henk M W Verheul; Tineke E Buffart; Lotte Bakkerus; Mariette Labots; Barbara M Zonderhuis; Jurriaan B Tuynman; Martijn R Meijerink; Peter M van de Ven; Cornelis J A Haasbeek; Albert J Ten Tije; Jan-Willem B de Groot; Mathijs P Hendriks; Esther van Meerten; Joost J M E Nuyttens; Dirk J Grunhagen Journal: Oncologist Date: 2020-06-16
Authors: Kaisa Lehtomäki; Hanna P Stedt; Emerik Osterlund; Timo Muhonen; Leena-Maija Soveri; Päivi Halonen; Tapio K Salminen; Juha Kononen; Raija Kallio; Annika Ålgars; Eetu Heervä; Annamarja Lamminmäki; Aki Uutela; Arno Nordin; Juho Lehto; Tiina Saarto; Harri Sintonen; Pirkko-Liisa Kellokumpu-Lehtinen; Raija Ristamäki; Bengt Glimelius; Helena Isoniemi; Pia Osterlund Journal: Cancers (Basel) Date: 2022-03-28 Impact factor: 6.639
Authors: Kristina Hasselgren; Bengt Isaksson; Bjarne Ardnor; Gert Lindell; Magnus Rizell; Cecilia Strömberg; Per Loftås; Bergthor Björnsson; Per Sandström Journal: Ann Transl Med Date: 2020-02