Preoperative selection of patients with colorectal cancer liver metastasis for hepatic resection. Mattar Rafif E,Al-Alem Faisal,Simoneau Eve,Hassanain Mazen World journal of gastroenterology Surgical resection of colorectal liver metastases (CRLM) has a well-documented improvement in survival. To benefit from this intervention, proper selection of patients who would be adequate surgical candidates becomes vital. A combination of imaging techniques may be utilized in the detection of the lesions. The criteria for resection are continuously evolving; currently, the requirements that need be met to undergo resection of CRLM are: the anticipation of attaining a negative margin (R0 resection), whilst maintaining an adequate functioning future liver remnant. The timing of hepatectomy in regards to resection of the primary remains controversial; before, after, or simultaneously. This depends mainly on the tumor burden and symptoms from the primary tumor. The role of chemotherapy differs according to the resectability of the liver lesion(s); no evidence of improved survival was shown in patients with resectable disease who received preoperative chemotherapy. Presence of extrahepatic disease in itself is no longer considered a reason to preclude patients from resection of their CRLM, providing limited extra-hepatic disease, although this currently is an area of active investigations. In conclusion, we review the indications, the adequate selection of patients and perioperative factors to be considered for resection of colorectal liver metastasis. 10.3748/wjg.v22.i2.567

Long-term outcome of liver resection for colorectal metastases in the presence of extrahepatic disease: A multi-institutional Japanese study. Sawada Yu,Sahara Kota,Endo Itaru,Sakamoto Katsunori,Honda Goro,Beppu Toru,Kotake Kenjiro,Yamamoto Masakazu,Takahashi Keiichi,Hasegawa Kiyoshi,Itabashi Michio,Hashiguchi Yojiro,Kotera Yoshihito,Kobayashi Shin,Yamaguchi Tatsuro,Tabuchi Ken,Kobayashi Hirotoshi,Yamaguchi Kensei,Morita Satoshi,Natsume Soichiro,Miyazaki Masaru,Sugihara Kenichi Journal of hepato-biliary-pancreatic sciences BACKGROUND/PURPOSE:The purpose of the present study was to assess long-term outcomes following liver resection for colorectal liver metastases (CRLM) with concurrent extrahepatic disease and to identify the preoperative prognostic factors for selection of operative candidates. METHODS:In this retrospective, multi-institutional study, 3820 patients diagnosed with CRLM during 2005-2007 were identified using nationwide survey data. Data of identified patients with concurrent extrahepatic lesions were analyzed to estimate the impact of liver resection on overall survival (OS) and to identify preoperative, prognostic indicators. RESULTS:Three- and 5-year OS rates after liver resection in 251 CRLM patients with extrahepatic disease (lung, n = 116; lymph node, n = 51; peritoneal, n = 37; multiple sites, n = 23) were 50.2% and 32.0%, respectively. Multivariate analysis revealed that a primary tumor in the right colon, lymph node metastasis from the primary tumor, serum carbohydrate antigen (CA) 19-9 level >37 UI/mL, the site of extrahepatic disease, and residual liver tumor after hepatectomy were associated with higher mortality. We proposed a preoperative risk scoring system based on these factors that adequately discriminated 5-year OS after liver resection in training and validation datasets. CONCLUSIONS:Performing R0 liver resection for colorectal liver metastases with treatable extrahepatic disease may prolong survival. Our proposed scoring system may help select appropriate candidates for liver resection. 10.1002/jhbp.810

Hepatic resection for colorectal metastases. Frankel Timothy L,D'Angelica Michael I Journal of surgical oncology The liver represents a common site for metastasis in colorectal cancer. Improvements in patient selection and surgical techniques has resulted in improved outcomes following hepatic metastasectomy with large series reporting 5- and 10-year overall survival rates of 40% and 20%, respectively. In recent years, criteria for resectability has expanded with the use of forced liver hypertrophy and staged resection. The role of perioperative chemotherapy remains controversial with a slight increase in survival and operative morbidity. 10.1002/jso.23371

Usefulness of intraoperative ultrasonography in liver resections due to colon cancer metastasis. Lucchese Angélica Maria,Kalil Antônio Nocchi,Schwengber Alex,Suwa Eiji,Rolim de Moura Gabriel Garcia International journal of surgery (London, England) INTRODUCTION:Intraoperative ultrasonography (IOUS) of the liver has been used both as an aid for intraoperative anatomical definition and for the detection of new lesions. The present study aimed to evaluate the impact of IOUS and to identify factors that can predict the detection of new lesions intraoperatively. METHODS:In this observational and prospective study, with a cross-sectional design, patients with colorectal cancer metastases who underwent hepatectomy were selected. Abdominal computed tomography, magnetic resonance imaging, and positron emission tomography were the preoperative evaluation tests. All patients underwent IOUS performed by the same surgeon. The intraoperative findings were compared with the preoperative tests results. RESULTS:In total, 56 hepatectomies were evaluated. Half of the patients were men, with a mean age of 57 (30-85) years. New lesions were found intraoperatively in 12 patients (21.4% of cases) and were detected on both palpation and ultrasonography in 11 of these patients. Ultrasonography helped to revise the surgical plans by providing additional information in 35.7% of cases. On multivariate analysis, the presence of more than 4 preoperative nodules was predictive of the intraoperative occurrence of new lesions. CONCLUSIONS:IOUS remains the only way to evaluate the relationships between tumors, liver vascular structures, and bile ducts intraoperatively. Alone, IOUS was not useful for identifying new lesions intraoperatively, as all new lesions were also detected on palpation. The number of lesions diagnosed on preoperative tests influenced the probability of identifying new lesions intraoperatively. There may be additional influential factors. 10.1016/j.ijsu.2015.06.053

Case Report of a 58-Year-Old Woman with Anatomic Segment IV and VII Liver Metastases from a Primary Colonic Adenocarcinoma Who Underwent Laparoscopic Cone Segmental Partial Hepatectomy. The American journal of case reports BACKGROUND Compared with wedge resection, anatomic segmental resection of liver metastases from primary colon cancer can improve tumor clearance and patient survival. We present the case of a 58-year-old woman with liver metastases from primary colon cancer who underwent laparoscopic cone unit resection for undetectable liver metastasis of segment VII. CASE REPORT The patient was a 58-year-old woman. Giant uterine myoma and advanced sigmoid colon cancer were detected on computed tomography. Two liver metastases (segments IV and VII) were simultaneously detected. The lesion of segment VII (5.0 mm in size) was not detected by echography and was located in the root of the hepatic vein, which connects to the right hepatic vein. However, the echography detected the hepatic vein. Therefore, we set the vein as the landmark of the undetectable liver tumor and planned to perform cone unit resection of segment VII with resection of the hepatic vein laparoscopically. We detected the landmark-set hepatic vein on intraoperative echography and transected the peripheral Glisson VII. Subsequently, the right hepatic vein was exposed from the root to the peripheral side and transected in its root. Cone unit resection was performed without tumor exposure. Operation time and blood loss were 582 min and 200 g, respectively. Pringle maneuver time, including hepatectomy of segments IV and VII, was 146 min. She was discharged on postoperative day 5 with no postoperative complications. CONCLUSIONS This case demonstrated the use of laparoscopic cone unit hepatectomy using an anatomical landmark in a patient with undetectable liver metastasis. 10.12659/AJCR.936115