Liver

Question 1

Liver ressection - Margins
Annals of Surgery, 2007 (MSKCC)
Retrospective analysis, prospective database

A margin width of >1cm is independently associated with the best long-term outcome and should be attempted whenever possivel.

Answer 1

1019 patients
Involved x 1cm
Margin width was a significant factor when comparing group III with groups I and II, but there was no significance between groups II and I (multivariate analysis).
Even in patients with subcentimeter resections, the long-term survival is still favorable.
Factors associated with a narrower margin width were bilateral resection and the presence of >= hepatic tumors.
Size >5cm and CEA>200 were marginally associated with closer margins.

Question 2

pCR - Predictors
Cancer 2010 (MSKCC, Univ. of Otawa - CAN)
Inclusion criteria

Obs.: no patient received bevacizumab or ctuximab as part of their chemotherapy regimen before LM disappearance.

Answer 2

1)

Question 3

pCR - Predictors
Cancer 2010 (MSKCC, Univ. of Otawa - CAN)

Answer 3

39 patients with 166 LMs, 118 DLMs

True CR rate among DLMs was (64%)

Question 4

pCR - Predictors
Cancer 2010 (MSKCC, Univ. of Otawa - CAN)
Predictors of True CR

Answer 4

Surrounding liver not steatotic
BMI <30kg/m2
LM not detectable on an MRI
CEA levels normalized during CxT
LMs treated with HAI

Question 5

pCR - Predictors
Cancer 2010 (MSKCC, Univ. of Otawa - CAN)

Answer 5

Median time to disappearance of LMs was 5 months. 25% diappeared within 3 months.
MRI was able to identify approximately 15% of DLMs

Question 6

Pre-op FDG-PET for liver resection

Annals of Surgery March 2001

Answer 6

43 patients
FDG-PET identified additional cancer no seen on CT in 10 patients. Surgery was contraindicated in six.
Laparotomy was performed in 37 patients. In all but two, liver resection was performed.

Question 7

MSKCC SPN series

J Am Coll Surgeons, 2010

Answer 7

160 patients - 43% had SPN identified preop.
Median number was 1 and median size 3mm
Unilateral in 77%
Calcified in 19%
At median followup of 31 months for survivors, 35% of patients ultimately demonstrated SPN progression and had their SPN proven to be metastatic disease (radiologic changes or histologic confirmation).

Question 8

MSKCC SPN series

J Am Coll Surgeons, 2010

Answer 8

SPN are common among patients undergoing resection of colorectal cancer liver metastases and approximately one-third of these will prove to be metastatic disease
Limited preoperative SPN might be associated with shorter PFS after hepatectomy, but does not substantially impact 3-year DSS, and should not necessarily preclde resection of hepatic metastases.

Question 9

MSKCC HAI (conversion to resectability)
JCO 2009
The hepatic extraction rate with HAI of floxuridine is 95%, producing minimal systemic toxicity and allowing concomitant administration of systemic chemotherapy such as oxaliplatin  and irinotecan at nearly full doses.

Answer 9

Patients with unresectable liver metastases from colorectal cancer treated with HAI floxuridine and dexamethasone plus systemic chemotherapy with oxalaplatin and irinotecan.
49 patients:
- 92% of response (8% complete and 84% partial)
- 47% were able to undergo resection (57% in CxT naive patients)

Question 10

MSKCC reponse to Neoadjv. CxT does not predict overall suvival for synchronous CLMs
Ann Surg Onc 2009

Answer 10

111 patients with a synchronous CLM who received neoadjuvant chemotherapy before hepatic resetion
Response to neoadjuvant chemotherapy did not correlate with OS even after controlling for margins, stage of primary tumor, and postoperative CEA level.