Skip to main content

Advertisement

SpringerLink
Log in

Complex Surgical Strategies to Improve Resectability in Borderline-Resectable Disease

  • Colorectal Cancer Hepatic Metastases (MA Choti, Section Editor)
  • Published:
Current Colorectal Cancer Reports

Abstract

Colorectal cancer is the third most common malignancy in the USA and continues to pose a significant epidemiologic problem, despite major advances in the treatment of patients with advanced disease. Up to 50 % of patients will develop metastatic disease at some point during the course of their disease, with the liver being the most common site of metastatic disease. In this review, we address the relatively poorly defined entity of borderline-resectable colorectal liver metastases. The workup and staging of borderline-resectable disease are discussed. We then discuss management strategies, including surgical techniques and medical therapies, which are currently utilized in order to improve resectability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Siegel R, DeSantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64:104–17.

    Article  PubMed  Google Scholar 

  2. Tzeng CW, Aloia TA. Colorectal liver metastases. J Gastrointest Surg. 2013;17:195–201.

    Article  PubMed  Google Scholar 

  3. Frankel TL, D’Angelica MI. Hepatic resection for colorectal metastases. J Surg Oncol. 2014;109:2–7.

    Article  PubMed  Google Scholar 

  4. Abdalla EK, Adam R, Bilchik AJ, et al. Improving resectability of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol. 2006;13:1271–80.

    Article  PubMed  Google Scholar 

  5. Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2002;235:759–66.

    Article  PubMed Central  PubMed  Google Scholar 

  6. House MG, Ito H, Gonen M, et al. Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1,600 patients during two decades at a single institution. J Am Coll Surg. 2010;210:744–5.

    Article  PubMed  Google Scholar 

  7. Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25:4575–80.

    Article  PubMed  Google Scholar 

  8. Wagner JS, Adson MA, van Heerden JA, et al. The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg. 1984;199:502–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Gallagher DJ, Kemeny N. Metastatic colorectal cancer: from improved survival to potential cure. Oncology. 2010;78:237–48.

    Article  PubMed  Google Scholar 

  10. Pawlik TM, Choti MA. Surgical therapy for colorectal metastases to the liver. J Gastrointest Surg. 2007;11:1057–77.

    Article  PubMed  Google Scholar 

  11. Adams RB, Aloia TA, Loyer E et al. Selection for hepatic resection of colorectal liver metastases: expert consensus statement. HPB (Oxford) 2013; 15:91-103. Recent consensus guidelines on evaluation of resectability of CRLM with additional reading on disappearing CRLM following chemotherapy.

  12. Zorzi D, Laurent A, Pawlik TM, et al. Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg. 2007;94:274–86.

    Article  CAS  PubMed  Google Scholar 

  13. Sahani DV, Bajwa MA, Andrabi Y, et al. Current status of imaging and emerging techniques to evaluate liver metastases from colorectal carcinoma. Ann Surg. 2014;259:861–72. Complete review on imaging modalities used in the evaluation of CRLM.

    Article  PubMed  Google Scholar 

  14. Wiering B, Ruers TJ, Krabbe PF, et al. Comparison of multiphase CT, FDG-PET and intra-operative ultrasound in patients with colorectal liver metastases selected for surgery. Ann Surg Oncol. 2007;14:818–26.

    Article  CAS  PubMed  Google Scholar 

  15. Wiering B, Krabbe PF, Dekker HM, et al. The role of FDG-PET in the selection of patients with colorectal liver metastases. Ann Surg Oncol. 2007;14:771–9.

    Article  CAS  PubMed  Google Scholar 

  16. Auer RC, White RR, Kemeny NE, et al. Predictors of a true complete response among disappearing liver metastases from colorectal cancer after chemotherapy. Cancer. 2010;116:1502–9.

    Article  PubMed  Google Scholar 

  17. Kulemann V, Schima W, Tamandl D, et al. Preoperative detection of colorectal liver metastases in fatty liver: MDCT or MRI? Eur J Radiol. 2011;79:e1–6.

    Article  PubMed  Google Scholar 

  18. Sahani DV, Kalva SP, Fischman AJ, et al. Detection of liver metastases from adenocarcinoma of the colon and pancreas: comparison of mangafodipir trisodium-enhanced liver MRI and whole-body FDG PET. AJR Am J Roentgenol. 2005;185:239–46.

    Article  PubMed  Google Scholar 

  19. Holalkere NS, Sahani DV, Blake MA, et al. Characterization of small liver lesions: added role of MR after MDCT. J Comput Assist Tomogr. 2006;30:591–6.

    Article  PubMed  Google Scholar 

  20. Ruers T. The multidisciplinary approach to colorectal cancer liver metastases. Oncology (Williston Park) 2009; 23:1071, 1077.

  21. Fong Y, Saldinger PF, Akhurst T, et al. Utility of 18F-FDG positron emission tomography scanning on selection of patients for resection of hepatic colorectal metastases. Am J Surg. 1999;178:282–7.

    Article  CAS  PubMed  Google Scholar 

  22. Ruers TJ, Langenhoff BS, Neeleman N, et al. Value of positron emission tomography with [F-18]fluorodeoxyglucose in patients with colorectal liver metastases: a prospective study. J Clin Oncol. 2002;20:388–95.

    Article  CAS  PubMed  Google Scholar 

  23. Truant S, Huglo D, Hebbar M, et al. Prospective evaluation of the impact of [18F]fluoro-2-deoxy-D-glucose positron emission tomography of resectable colorectal liver metastases. Br J Surg. 2005;92:362–9.

    Article  CAS  PubMed  Google Scholar 

  24. Moulton CA, Gu CS, Law CH, et al. Effect of PET before liver resection on surgical management for colorectal adenocarcinoma metastases: a randomized clinical trial. JAMA. 2014;311:1863–9.

    Article  CAS  PubMed  Google Scholar 

  25. Coenegrachts K, De GF, ter Beek L, et al. Comparison of MRI (including SS SE-EPI and SPIO-enhanced MRI) and FDG-PET/CT for the detection of colorectal liver metastases. Eur Radiol. 2009;19:370–9.

    Article  PubMed  Google Scholar 

  26. Akhurst T, Kates TJ, Mazumdar M, et al. Recent chemotherapy reduces the sensitivity of [18F]fluorodeoxyglucose positron emission tomography in the detection of colorectal metastases. J Clin Oncol. 2005;23:8713–6.

    Article  PubMed  Google Scholar 

  27. Chun YS, Ribero D, Abdalla EK, et al. Comparison of two methods of future liver remnant volume measurement. J Gastrointest Surg. 2008;12:123–8.

    Article  PubMed  Google Scholar 

  28. Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg. 2003;7:325–30.

    Article  PubMed  Google Scholar 

  29. Kishi Y, Abdalla EK, Chun YS, et al. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg. 2009;250:540–8.

    PubMed  Google Scholar 

  30. Jarnagin WR, Fong Y, Ky A, et al. Liver resection for metastatic colorectal cancer: assessing the risk of occult irresectable disease. J Am Coll Surg. 1999;188:33–42.

    Article  CAS  PubMed  Google Scholar 

  31. Bickenbach KA, DeMatteo RP, Fong Y, et al. Risk of occult irresectable disease at liver resection for hepatic colorectal cancer metastases: a contemporary analysis. Ann Surg Oncol. 2013;20:2029–34.

    Article  PubMed  Google Scholar 

  32. Hoch G, Croise-Laurent V, Germain A, et al. Is intraoperative ultrasound still useful for the detection of colorectal cancer liver metastases? HPB (Oxford). 2015;17:514–9.

    Article  Google Scholar 

  33. Knowles SA, Bertens KA, Croome KP, et al. The current role of intraoperative ultrasound during the resection of colorectal liver metastases: a retrospective cohort study. Int J Surg. 2015;20:101–6.

    Article  PubMed  Google Scholar 

  34. Arita J, Ono Y, Takahashi M et al. Routine Preoperative Liver-Specific Magnetic Resonance Imaging Does Not Exclude the Necessity of Contrast-Enhanced Intraoperative Ultrasound in Hepatic Resection for Colorectal Liver Metastasis. Ann Surg 2015.

  35. Leen E, Ceccotti P, Moug SJ, et al. Potential value of contrast-enhanced intraoperative ultrasonography during partial hepatectomy for metastases: an essential investigation before resection? Ann Surg. 2006;243:236–40.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Aloia TA, Fahy BN, Fischer CP, et al. Predicting poor outcome following hepatectomy: analysis of 2313 hepatectomies in the NSQIP database. HPB (Oxford). 2009;11:510–5.

    Article  PubMed Central  Google Scholar 

  37. Andres A, Toso C, Moldovan B, et al. Complications of elective liver resections in a center with low mortality: a simple score to predict morbidity. Arch Surg. 2011;146:1246–52.

    Article  PubMed  Google Scholar 

  38. Are C, Gonen M, Zazzali K, et al. The impact of margins on outcome after hepatic resection for colorectal metastasis. Ann Surg. 2007;246:295–300.

    Article  PubMed Central  PubMed  Google Scholar 

  39. DeMatteo RP, Palese C, Jarnagin WR, et al. Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases. J Gastrointest Surg. 2000;4:178–84.

    Article  CAS  PubMed  Google Scholar 

  40. Kingham TP, Correa-Gallego C, D’Angelica MI, et al. Hepatic parenchymal preservation surgery: decreasing morbidity and mortality rates in 4,152 resections for malignancy. J Am Coll Surg. 2015;220:471–9. Recent large analysis from our institution’s prospectively-maintained database of over 4,000 hepatic resections.

    Article  PubMed  Google Scholar 

  41. Pawlik TM, Scoggins CR, Zorzi D et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 2005; 241:715-22, discussion.

  42. Gold JS, Are C, Kornprat P, et al. Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg. 2008;247:109–17.

    Article  PubMed  Google Scholar 

  43. Abdalla EK, Barnett CC, Doherty D, et al. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg. 2002;137:675–80.

    Article  PubMed  Google Scholar 

  44. Abdalla EK. Portal vein embolization (prior to major hepatectomy) effects on regeneration, resectability, and outcome. J Surg Oncol. 2010;102:960–7.

    Article  PubMed  Google Scholar 

  45. Charnsangavej C, Clary B, Fong Y, et al. Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol. 2006;13:1261–8.

    Article  PubMed  Google Scholar 

  46. Kubota K, Makuuchi M, Kusaka K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997;26:1176–81.

    CAS  PubMed  Google Scholar 

  47. Shirabe K, Shimada M, Gion T, et al. Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg. 1999;188:304–9.

    Article  CAS  PubMed  Google Scholar 

  48. van den Broek MA, Olde Damink SW, Dejong CH, et al. Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int. 2008;28:767–80.

    Article  PubMed  Google Scholar 

  49. Hammond JS, Guha IN, Beckingham IJ, et al. Prediction, prevention and management of postresection liver failure. Br J Surg. 2011;98:1188–200.

    Article  CAS  PubMed  Google Scholar 

  50. Guglielmi A, Ruzzenente A, Conci S, et al. How much remnant is enough in liver resection? Dig Surg. 2012;29:6–17.

    Article  PubMed  Google Scholar 

  51. Rous P, Larimore LD. Relation of the portal blood to liver maintenance: a demonstration of liver atrophy conditional on compensation. J Exp Med. 1920;31:609–32.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  52. Kinoshita H, Sakai K, Hirohashi K, et al. Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg. 1986;10:803–8.

    Article  CAS  PubMed  Google Scholar 

  53. Abulkhir A, Limongelli P, Healey AJ, et al. Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg. 2008;247:49–57.

    Article  PubMed  Google Scholar 

  54. Chun YS, Vauthey JN, Ribero D, et al. Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival. J Gastrointest Surg. 2007;11:1498–504.

    Article  PubMed  Google Scholar 

  55. Jaeck D, Bachellier P, Nakano H, et al. One or two-stage hepatectomy combined with portal vein embolization for initially nonresectable colorectal liver metastases. Am J Surg. 2003;185:221–9.

    Article  PubMed  Google Scholar 

  56. Shindoh J, Truty MJ, Aloia TA, et al. Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant. J Am Coll Surg. 2013;216:201–9.

    Article  PubMed Central  PubMed  Google Scholar 

  57. Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012;255:405–14.

    Article  PubMed  Google Scholar 

  58. Aloia TA, Vauthey JN. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): what is gained and what is lost? Ann Surg. 2012;256:e9.

    Article  PubMed  Google Scholar 

  59. Abdalla EK, Bauer TW, Chun YS, et al. Locoregional surgical and interventional therapies for advanced colorectal cancer liver metastases: expert consensus statements. HPB (Oxford). 2013;15:119–30. Recent consensus guidelines on timing and management options in the treatment of extensive CRLM.

    Article  Google Scholar 

  60. Mulier S, Ni Y, Jamart J, et al. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg. 2005;242:158–71.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Kingham TP, Tanoue M, Eaton A, et al. Patterns of recurrence after ablation of colorectal cancer liver metastases. Ann Surg Oncol. 2012;19:834–41. Recent review showing increased local recurrence following ablation of CRLM larger than 1 cm.

    Article  PubMed  Google Scholar 

  62. Karanicolas PJ, Jarnagin WR, Gonen M, et al. Long-term outcomes following tumor ablation for treatment of bilateral colorectal liver metastases. JAMA Surg. 2013;148:597–601.

    Article  PubMed Central  PubMed  Google Scholar 

  63. Groeschl RT, Pilgrim CH, Hanna EM, et al. Microwave ablation for hepatic malignancies: a multiinstitutional analysis. Ann Surg. 2014;259:1195–200.

    Article  PubMed  Google Scholar 

  64. Leung U, Kuk D, D’Angelica MI, et al. Long-term outcomes following microwave ablation for liver malignancies. Br J Surg. 2015;102:85–91.

    Article  CAS  PubMed  Google Scholar 

  65. Correa-Gallego C, Fong Y, Gonen M, et al. A retrospective comparison of microwave ablation vs. radiofrequency ablation for colorectal cancer hepatic metastases. Ann Surg Oncol. 2014;21:4278–83.

    Article  PubMed  Google Scholar 

  66. Cannon R, Ellis S, Hayes D, et al. Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures. J Surg Oncol. 2013;107:544–9.

    Article  PubMed  Google Scholar 

  67. Kingham TP, Karkar AM, D’Angelica MI, et al. Ablation of perivascular hepatic malignant tumors with irreversible electroporation. J Am Coll Surg. 2012;215:379–87.

    Article  PubMed  Google Scholar 

  68. Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013;14:1208–15. Landmark updated trial showing no difference between perioperative chemotherapy and surgery versus surgery alone on survival in CRLM.

    Article  CAS  PubMed  Google Scholar 

  69. Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371:1007–16.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  70. Chua TC, Saxena A, Liauw W, et al. Systematic review of randomized and nonrandomized trials of the clinical response and outcomes of neoadjuvant systemic chemotherapy for resectable colorectal liver metastases. Ann Surg Oncol. 2010;17:492–501.

    Article  PubMed  Google Scholar 

  71. Vauthey JN, Pawlik TM, Ribero D, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol. 2006;24:2065–72.

    Article  CAS  PubMed  Google Scholar 

  72. Jarnagin WR, Conlon K, Bodniewicz J, et al. A clinical scoring system predicts the yield of diagnostic laparoscopy in patients with potentially resectable hepatic colorectal metastases. Cancer. 2001;91:1121–8.

    Article  CAS  PubMed  Google Scholar 

  73. Adam R, De GA, Figueras J, et al. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist. 2012;17:1225–39.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  74. Worni M, Shah KN, Clary BM. Colorectal cancer with potentially resectable hepatic metastases: optimizing treatment. Curr Oncol Rep. 2014;16:407.

    Article  PubMed  Google Scholar 

  75. Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57.

    Article  PubMed Central  PubMed  Google Scholar 

  76. Saltz LB, Clarke S, Diaz-Rubio E, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol. 2008;26:2013–9.

    Article  CAS  PubMed  Google Scholar 

  77. Peeters M, Price TJ, Cervantes A, et al. Randomized phase III study of panitumumab with fluorouracil, leucovorin, and irinotecan (FOLFIRI) compared with FOLFIRI alone as second-line treatment in patients with metastatic colorectal cancer. J Clin Oncol. 2010;28:4706–13.

    Article  CAS  PubMed  Google Scholar 

  78. Douillard JY, Siena S, Cassidy J, et al. Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol. 2010;28:4697–705.

    Article  CAS  PubMed  Google Scholar 

  79. Tournigand C, Andre T, Achille E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol. 2004;22:229–37.

    Article  CAS  PubMed  Google Scholar 

  80. Kemeny N. The management of resectable and unresectable liver metastases from colorectal cancer. Curr Opin Oncol. 2010;22:364–73.

    Article  PubMed  Google Scholar 

  81. Adam R, Aloia T, Levi F, et al. Hepatic resection after rescue cetuximab treatment for colorectal liver metastases previously refractory to conventional systemic therapy. J Clin Oncol. 2007;25:4593–602.

    Article  CAS  PubMed  Google Scholar 

  82. Van CE, Lambrechts D, Prenen H, et al. Lessons from the adjuvant bevacizumab trial on colon cancer: what next? J Clin Oncol. 2011;29:1–4.

    Article  Google Scholar 

  83. Van CE, Kohne CH, Lang I, et al. Cetuximab plus irinotecan, fluorouracil, and leucovorin as first-line treatment for metastatic colorectal cancer: updated analysis of overall survival according to tumor KRAS and BRAF mutation status. J Clin Oncol. 2011;29:2011–9.

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  85. Cauchy F, Aussilhou B, Dokmak S, et al. Reappraisal of the risks and benefits of major liver resection in patients with initially unresectable colorectal liver metastases. Ann Surg. 2012;256:746–52.

    Article  PubMed  Google Scholar 

  86. BREEDIS C, YOUNG G. The blood supply of neoplasms in the liver. Am J Pathol. 1954;30:969–77.

    PubMed Central  CAS  PubMed  Google Scholar 

  87. D’Angelica MI, Correa-Gallego C, Paty PB, et al. Phase II trial of hepatic artery infusional and systemic chemotherapy for patients with unresectable hepatic metastases from colorectal cancer: conversion to resection and long-term outcomes. Ann Surg. 2015;261:353–60. Recent prospective trial demonstrating a 47% conversion rate to resectability from extensive unresectable CRLM with use of hepatic arterial infusion pump therapy.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Motaz Qadan and Michael I. D’Angelica declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C898, New York, NY, 10065, USA

    Motaz Qadan & Michael I. D’Angelica

Authors
  1. Motaz Qadan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael I. D’Angelica
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael I. D’Angelica.

Additional information

This article is part of the Topical Collection on Colorectal Cancer Hepatic Metastases

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qadan, M., D’Angelica, M.I. Complex Surgical Strategies to Improve Resectability in Borderline-Resectable Disease. Curr Colorectal Cancer Rep 11, 369–377 (2015). https://doi.org/10.1007/s11888-015-0290-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11888-015-0290-5

Keywords

Search

Navigation