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Indications for conversion hepatectomy for initially unresectable colorectal cancer with liver metastasis

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Abstract

Purpose

Selected patients with initially unresectable colorectal cancer (CRC) and liver metastases undergo conversion surgery after appropriate chemotherapy. The prognosis of these patients is good, with some even cured of the disease. This retrospective, single-institution study analyzes the clinical importance of patient characteristics on the outcomes of conversion hepatectomy.

Methods

We evaluated 229 consecutive patients with initially unresectable CRC and liver metastasis, who underwent systemic chemotherapy. The patients were assigned to groups depending on conversion hepatectomy.

Results

Conversion hepatectomy was performed in 30 patients (13.1%). The proportion of patients with extrahepatic metastasis was significantly lower in the conversion group than in the unresectable group (30.0 vs. 66.8%; P < 0.01). The rate of left-sided primary colorectal tumors was significantly higher in the conversion group than in the unresectable group (96.7 vs. 65.8%; P < 0.01). Multivariate analyses identified that left-sided tumors, no extrahepatic metastasis, H1 or H2 grade CLM, and treatment with molecular-targeted agents were associated with conversion hepatectomy (odds ratios: 16.314, 4.216, 7.631, and 4.070; P < 0.01). Overall survival was significantly longer in the conversion group than in the unresectable group (MST: 50.0 versus 14.7 months; P < 0.01).

Conclusion

Left-sided primary tumors, absence of extrahepatic metastases, H1 or H2 grade, and use of molecular-targeted agents were associated with successful conversion hepatectomy; thus, patients with these characteristics may be candidates for conversion therapy.

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References

  1. Oki E, Ando K, Nakanishi R, Sugiyama M, Nakashima Y, Kubo N, et al. Recent advances in treatment for colorectal liver metastasis. Ann Gastroenterol Surg. 2018;2:167–75.

    Article  Google Scholar 

  2. National Comprehensive Cancer Network (NCCN) guideline for colon cancer. https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf.

  3. Van Cutsem E, Cervantes A, Nordlinger B, Arnold D, Group EGW. Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25(Suppl 3):iii1–9.

    PubMed  Google Scholar 

  4. Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020;25:1–42.

    Article  Google Scholar 

  5. Goldberg RM, Sargent DJ, Morton RF, Fuchs CS, Ramanathan RK, Williamson SK, et al. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol. 2004;22:23–30.

    Article  CAS  Google Scholar 

  6. Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal, appendiceal, and anal carcinoma. Tokyo: Kanehara & CO., Ltd.; 2019.

    Google Scholar 

  7. Yoshino T, Arnold D, Taniguchi H, Pentheroudakis G, Yamazaki K, Xu RH, et al. Pan-Asian adapted ESMO consensus guidelines for the management of patients with metastatic colorectal cancer: a JSMO-ESMO initiative endorsed by CSCO, KACO, MOS SSO and TOS. Ann Oncol. 2018;29:44–70.

    Article  CAS  Google Scholar 

  8. Kato T, Yasui K, Hirai T, Kanemitsu Y, Mori T, Sugihara K, et al. Therapeutic results for hepatic metastasis of colorectal cancer with special reference to effectiveness of hepatectomy: analysis of prognostic factors for 763 cases recorded at 18 institutions. Dis Colon Rectum. 2003;46:S22-31.

    PubMed  Google Scholar 

  9. Japanese Society for Cancer of the C, Rectum. Japanese Classification of Colorectal, appendiceal, and anal carcinoma: the 3d English Edition [Secondary Publication]. J Anus Rectum Colon. 2019;3:175–95.

    Article  Google Scholar 

  10. Beppu T, Miyamoto Y, Sakamoto Y, Imai K, Nitta H, Hayashi H, et al. Chemotherapy and targeted therapy for patients with initially unresectable colorectal liver metastases, focusing on conversion hepatectomy and long-term survival. Ann Surg Oncol. 2014;21(Suppl 3):S405-413.

    Article  Google Scholar 

  11. Uetake H, Yasuno M, Ishiguro M, Kameoka S, Shimada Y, Takahashi K, et al. A multicenter phase II trial of mFOLFOX6 plus bevacizumab to treat liver-only metastases of colorectal cancer that are unsuitable for upfront resection (TRICC0808). Ann Surg Oncol. 2015;22:908–15.

    Article  Google Scholar 

  12. Nordlinger B, Van Cutsem E, Gruenberger T, Glimelius B, Poston G, Rougier P, et al. Combination of surgery and chemotherapy and the role of targeted agents in the treatment of patients with colorectal liver metastases: recommendations from an expert panel. Ann Oncol. 2009;20:985–92.

    Article  CAS  Google Scholar 

  13. Takatsuki M, Tokunaga S, Uchida S, Sakoda M, Shirabe K, Beppu T, et al. Evaluation of resectability after neoadjuvant chemotherapy for primary non-resectable colorectal liver metastases: a multicenter study. Eur J Surg Oncol. 2016;42:184–9.

    Article  CAS  Google Scholar 

  14. Arnold D, Lueza B, Douillard JY, Peeters M, Lenz HJ, Venook A, et al. Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials. Ann Oncol. 2017;28:1713–29.

    Article  CAS  Google Scholar 

  15. Tejpar S, Stintzing S, Ciardiello F, Tabernero J, Van Cutsem E, Beier F, et al. Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metastatic colorectal cancer: retrospective analyses of the CRYSTAL and FIRE-3 trials. JAMA Oncol. 2017;3:194–201.

    Article  Google Scholar 

  16. Yamashita S, Brudvik KW, Kopetz SE, Maru D, Clarke CN, Passot G, et al. Embryonic origin of primary colon cancer predicts pathologic response and survival in patients undergoing resection for colon cancer liver metastases. Ann Surg. 2018;267:514–20.

    Article  Google Scholar 

  17. Shida D, Tanabe T, Boku N, Takashima A, Yoshida T, Tsukamoto S, et al. Prognostic value of primary tumor sidedness for unresectable stage IV colorectal cancer: a retrospective study. Ann Surg Oncol. 2019;26:1358–65.

    Article  Google Scholar 

  18. Okuno M, Hatano E, Toda R, Nishino H, Nakamura K, Ishii T, et al. Conversion to complete resection with mFOLFOX6 with bevacizumab or cetuximab based on K-RAS status for unresectable colorectal liver metastasis (BECK study): Long-term results of survival. J Hepatobiliary Pancreat Sci. 2020;27:496–509.

    Article  Google Scholar 

  19. Marques MC, Ribeiro HSC, Costa WL Jr, de Jesus VHF, de Macedo MP, Diniz AL, et al. Is primary sidedness a prognostic factor in patients with resected colon cancer liver metastases (CLM)? J Surg Oncol. 2018;117:858–63.

    Article  CAS  Google Scholar 

  20. Wang K, Xu D, Yan XL, Poston G, Xing BC. The impact of primary tumour location in patients undergoing hepatic resection for colorectal liver metastasis. Eur J Surg Oncol. 2018;44:771–7.

    Article  Google Scholar 

  21. Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350:2335–42.

    Article  CAS  Google Scholar 

  22. Cunningham D, Humblet Y, Siena S, Khayat D, Bleiberg H, Santoro A, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med. 2004;351:337–45.

    Article  CAS  Google Scholar 

  23. Schindl MJ, Redhead DN, Fearon KC, Garden OJ, Wigmore SJ, Edinburgh Liver S, et al. The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut. 2005;54:289–96.

    Article  CAS  Google Scholar 

  24. Zipprich A, Kuss O, Rogowski S, Kleber G, Lotterer E, Seufferlein T, et al. Incorporating indocyanin green clearance into the Model for End Stage Liver Disease (MELD-ICG) improves prognostic accuracy in intermediate to advanced cirrhosis. Gut. 2010;59:963–8.

    Article  Google Scholar 

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Acknowledgements

We thank our assistants, Mrs. Miyazaki, Mrs. Koto, and Mrs. Tsuboi.

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Authors and Affiliations

  1. Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, Fukuoka, 811-1395, Japan

    Masahiko Sugiyama, Hideo Uehara, Yuki Shin, Keiichi Shiokawa, Yoshiaki Fujimoto, Yuichiro Nakashima, Manabu Yamamoto, Masaru Morita & Yasushi Toh

  2. Hepato-Biliary-Pancreatic Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan

    Yohei Mano & Keishi Sugimachi

  3. Gastrointestinal and Medical Oncology, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan

    Masato Komoda

Authors
  1. Masahiko Sugiyama
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  2. Hideo Uehara
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  3. Yuki Shin
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  4. Keiichi Shiokawa
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Correspondence to Masahiko Sugiyama.

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Sugiyama, M., Uehara, H., Shin, Y. et al. Indications for conversion hepatectomy for initially unresectable colorectal cancer with liver metastasis. Surg Today 52, 633–642 (2022). https://doi.org/10.1007/s00595-021-02403-5

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  • DOI: https://doi.org/10.1007/s00595-021-02403-5

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