How to deal with synchronous primary and liver metastases
|
|
- Caroline Harrison
- 5 years ago
- Views:
Transcription
1 How to deal with synchronous primary and liver metastases Luis Sabater Ortí MD, PhD Associate Professor University of Valencia European Board Surgical Qualification HBP (EBSQ-HPB) Department of Surgery. Liver-Biliary and Pancreatic Unit Hospital Clínico. University of Valencia
2 DISCLOSURE Nothing to disclose
3 Painting: Sandra Villa Lago Photograph: David Gimeno Veses School of Medicine. Universitat de Valencia
4 Definitions SYNCHRONIC Metastasis Diagnosed at the same time as the CRC Pre-operative staging Intraoperative finding (urgent surgery CRC) 3-6 months after resection % of patients with CRC SIMULTANEOUS SURGERY (Vogt P, 1991) SEQUENTIAL BOWEL-FIRST (80s and two-staged in 2000, Adam R) SEQUENTIAL LIVER FIRST (Mentha G, 2006)
5 Definitions, advantages and disadvantages Simultaneous: All liver metastases and the primary tumor are resected in the same operation Advantages Avoid two operations Beneficial psycological effects Resection of all disease, lower risk of dissemination Chemo starts early and in better oncological conditions Less morbidity Shorter length hospital stay Lower costs Disadvantages Long surgical time Specialised surgeons required The biological behaviour of the tumor is not observed Safety of bowel anastomosis Higher risk of occult liver metastases Bacterial contamination Infection / sepsis
6 Definitions, advantages and disadvantages Sequential bowel-first: First resection of the CRC and then the liver metastases. With or without Chemo during the interval. Advantages Less surgical time for each surgical operation No accumulation of risks in each surgery Better management of complex surgeries Allows evaluation of tumor behaviour With Chemo occult liver M1 or microm1 are treated With Chemo reduces M1 size: less parenchyma resection and higher R0 Evaluation response to Chemo and tolerance Less recurrence rate (?) Disease free survival longer (?) Disadvantages Two surgical operations Psychological effects Longer length of hospital stay If complications, delays liver surgery or Chemo Increase in morbidity If interval Chemo, toxicity may appear If interval Chemo, M1 can disappear Disease progression Unresectability Higher costs
7 Definitions, advantages and disadvantages Sequential bowel-first: Resection of the primary CRC and clearance of the less invaded liver. Then, complete resection of the liver metastases (after hypertrophy of the FLR) PORTAL Embolization
8 Definitions, advantages and disadvantages Sequential liver first (reverse approach): Resection first of all liver metastases and later the CRC. Always neoadjuvant chemo. Rationale 1 : the lesion that kills the patient is the metastasis Rationale 2: progression of the CRLM beyond resectability during treatment of the primary tumour, especially if delay is due to complications of primary resection or adjuvant chemotherapy. Advantages Chemo treatment of liver metastases and the primary CRC Avoids progression of liver metastases Allows the most appropriatte timing of administration of pelvis Chemo-RDT Early administration of Chemo Increase S if conversion of M1 to resectables Avoids palliative surgery of CRC and its complications Disadvantages Liver progression in cases of doubtful resectability with non-response to Chemo CRC progression (rare) Complications of primary CRC requiring urgent or palliative surgery (5-11 %) Long liver toxicity Small size liver M1 disappearance Short surgical window (6-12 months)
9 Scientific Evidence. Review Simultaneous liver & primary versus sequential Hillingso JG, Wille-Jorgensen P. Staged or simultaneous resection of synchronous liver metastases from colorectal cancer- a systematic review. Colorectal Disease 2009; 11:3-10 Brouquet A, Mortenson MM, Vauthey J-N et al. Surgical Strategies for Synchronous Colorectal Liver Metastases in 156 Consecutive Patients: Classic, Combined or Reverse Strategy? J Am Coll Surg 2010; 210: Slesser AAP, Simillis C, Goldin R, Brown G, Mudan S, Tekkis PP. A meta-analysis comparing simultaneous versus delayed resections in patients with synchronous colorectal liver metastases. Surgical Oncology 2013; 22: Baltatzis M, Chan AK, Jegatheeswaran S, Mason JM, Siriwardena AK. Colorectal cancer with synchronous hepatic metastases: Systematic review of reports comparing synchronous surgery with sequential bowel-first or liver-first approaches. Eur J Surg Oncol 2016; 42: Abelson JS, Michelassi F, Sun T, Mao J, Milsom J, Samstein B, Sedrakyan A, Yeo HL. Simultaneous resection for synchronous colorectal liver metastases : the new standard of care? J Gastrointest Surg 2017; 21:
10 Scientific Evidence. Review Simultaneous liver and primary versus sequential Hillingso JG, Wille-Jorgensen P. Staged or simultaneous resection of synchronous liver metastases from colorectal cancer-a systematic review. Colorectal Disease 2009; 11: studies, Biases (prevent meta-analysis): simultaneous more frequent in right colon Tm and limited resections sequential more frequent in bigger and multiple M1 Simultaneous surgery Sequential surgery Length of Hospital Stay 15 days 18 days Morbidity 33 % 42 % Mortality 3.6 % 1 % Survival = =
11 Scientific Evidence. Review Sequential LIVER FIRST Brouquet A, Mortenson MM, Vauthey J-N et al. Surgical Strategies for Synchronous Colorectal Liver Metastases in 156 Consecutive Patients: Classic, Combined or Reverse Strategy? J Am Coll Surg 2010; 210: Sequential Colon first N= 72 Simultaneous Colon & Liver N= 43 Sequential Liver first N= 27 Morbidity 51 % 47 % 31 % p NS Mortality 3 % 5 % 4 % p NS Survival (3, 5 years) 58 %, 48 % 65 %, 55 % 79 %, 39 % p NS Nº M p < 0.05 Major Hepatectomy 66 % 35 % 89 % p< 0.05 Sequential Liver First 5 % complications related to primary tumour 34 % do not complete primary tumour resection
12 Scientific Evidence. Review Simultaneous liver and primary versus sequential Slesser AAP, Simillis C, Goldin R, Brown G, Mudan S, Tekkis PP. A meta-analysis comparing simultaneous versus delayed resections in patients with synchronous colorectal liver metastases. Surgical Oncology 2013; 22: studies, : 3159 patients: 1381 Simultaneous (43.7 %) 1778 Sequential (56.3%) Biases: < Neoadjuvant Chemo in simultaneous More frequent bilobar and bigger M1 in sequential and higher rate of major resections in sequential Simultaneous surgery Sequential surgery Length of Hospital Stay 14 days 20 days Time of surgery = = Blood loss = 825 ml = 955 ml Free disease survival = = Survival = = Morbidity = 36 % = 37 %
13 Scientific Evidence. Review Simultaneous liver and primary versus sequential Baltatzis M, Chan AK, Jegatheeswaran S, Mason JM, Siriwardena AK. Colorectal cancer with synchronous hepatic metastases: Systematic review of reports comparing synchronous surgery with sequential bowel-first or liver-first approaches. Eur J Surg Oncol 2016; 42: studies, : 1203 patients: 748 Bowel first (62%) 380 Simultaneous (31.5%) 75 Liver first (6.5%) Minor complications similar Major complications : 9.1 % (95%CI: 7.6%-10.8%, I 2 =48%) Death: 3.1 % (95%CI: 2.2%-4.3%, I 2 =0%) 5-year survival 44% (I 2 =39%) Overall treatment-related mortality is low and survival is similar among the 3 groups.
14 Scientific Evidence. Review Simultaneous liver and primary versus sequential 135 Hospitals New York State Abelson JS et al. J Gastrointest Surg 2017
15 Scientific Evidence. Review Simultaneous liver and primary versus sequential Abelson JS et al. J Gastrointest Surg 2017
16 Scientific Evidence. Review Sturesson Ch et al. Liver-first strategy for synchronous colorectal liver metastases-an intention-to treat analysis. HBP 2017; 19: Liver-first 35 % Do not complete the planned treatment (two surgeries) Classical 30 % Do not complete the planned treatment (two surgeries)
17 Scientific Evidence. Review SIMULTANEOUS vs Sequential BOWEL FIRST vs Sequential LIVER FIRST Summary Scientific Evidence None randomized (RCT) studies Important selection biases Sequential in patients with greater liver disease No clear evidence Simultaneous and sequential resections are equally feasible and safe in selected cases Simultaneous short length of hospital stay and same survival Liver first approach is an option in patients with synchronous M1 and asymptomatic primary tumour Despite having greater metastatic disease, same survival as the simultaneous or bowel-first approach
18 Indications and clinical recommendations SIMULTANEOUS Surgery Patients with good general condition who can withstand the 2 procedures (colon and liver) (longer time and greater aggressiveness) High possibility of R0 resection in both fields (no matter the number, size or location of M1) Sufficient liver remnant (25-40%) (2 contiguous segments with their vascular pedicles and biliary drainage) No extrahepatic disease or resectable (pulmonary metastases) Uncomplicated primary tumor: no occlusion, no perforation, no hemorrhage Specialized surgeons and estimated surgery times <6 hours (variable) Do not associate complex surgeries in the two fields
19 Indications and clinical recommendations SIMULTANEOUS Surgery During surgery, reevaluate if continue with the 2 procedures (safety) No peritoneal spread No severe complications during the first resection Resection of all metastases seen on intraoperative ultrasound First liver metastases or first colorectal tumor? 1º liver: Liver surgery without contamination Work with low PVC (<5 mmhg) without affecting this hypovolemia to the colorectal anastomosis Avoid colon edema (on the anastomosis) by Pringle 1º CRC: R0 safety in the primary Pringle manouvre as short as posible (only if necessary)
20 Indications and clinical recommendations SEQUENTIAL COLON FIRST Surgery Patient with comorbidities that prevent 2 simultaneous surgeries Surgeon who is not an expert in liver surgery Doubtful resectability (R0) or unresectability of M1 or CCR Very long estimated surgical time Complex surgery of the CRC and the M1 Complicated CRC: obstruction, perforation... Bilobar metastases, adjacent to large vessels or liver remnant <25-40% Extrahepatic metastases
21 Indications and clinical recommendations SEQUENTIAL LIVER FIRST Surgery Asymptomatic primary tumor or minimal symptoms (treatable by endoscopy) Unresectable or borderline resectable liver M1 M1 hepatic and extrahepatic unresectable or doubtfully resectable (initially) Hepatic M1 of doubtful resectability with uncomplicated primary but doubtful resectability with oncological criteria Large or multiple liver M1 at risk of becoming unresectable if they progress after resection of the primary
22 Synchronous primary CRC and liver metastases Trends in surgical strategy Vallance AE et al. The timing of liver resection in patients with colorectal cancer and synchronous liver metastases: a population-based study of current practice and survival. Colorectal Dis 2018
23 Synchronous primary CRC and liver metastases Management of the disappearing metastases (after chemotherapy) Incidence: 5-38 % MRI more accurate than CT for detecting lesions after chemo Try to avoid this problem Early involvement of surgeon: Multidisciplinary board Limit the duration of chemo: short course or stop when response allow surgical resection Coils to mark M1 if risk of dissapearing Ability to detect missing M1 at the time of surgery varies widely: % Complete pathological or durable clinical response in 26 % - 82 % of patients (mean= 54%) Complete radiological response IS NOT EQUIVALENT to complete pathological response Surgical resection should include all original sites of M1 when feasible When such resections are hazardous, a watch-and-wait strategy can be a reasonable alternative Adams RB et al. Selection for hepatic resection of colorectal liver metastases: expert consensus statement. HBP 2013; 15: Lucidi V et al. Missing metastases as a model to challenge current therapeutic algorithms in colorectal liver metastases. World J Gastroenterol 2016; 22:
24 Simultaneous with primary, sequential bowel-first or liver-first Indications and clinical recommendations Complexity of the colorectal tumor Complexity of liver surgery Comorbidities of the patient-general condition SELECTION Patient fitness Anatomical location: colon, rectum, liver Extent of liver metastases
25 Synchronous primary and liver metastases Summary Multidisciplinary Board Oncological and Surgical strategies Selection of patients for each strategy Planification for an appropriate sequential treatment Simultaneous, bowel-first or liver-first Complex surgical procedures requiring surgical expertise
26
27 Thank you!!
How to integrate surgery in the treatment of patients with liver-only metastatic disease
How to integrate surgery in the treatment of patients with liver-only metastatic disease Luis Sabater Ortí MD, PhD Associate Professor University of Valencia European Board Surgical Qualification HBP (EBSQ-HPB)
More informationTreatment of Colorectal Liver Metastases State of the Art
Treatment of Colorectal Liver Metastases State of the Art Eddie K. Abdalla, MD, FACS Professor and Chairman of Surgery Chief of Hepatobiliary Surgery Hilton Metropolitan Palace Hotel Beirut 16 November,
More informationMultidisciplinary Treatment Strategies for Primary and Metastatic Liver Cancers
Multidisciplinary Treatment Strategies for Primary and Metastatic Liver Cancers Ching-Wei D. Tzeng, M.D. Assistant Professor Surgical Oncology University of Kentucky Markey Cancer Center Affiliate Network
More informationManchester Cancer Colorectal Pathway Board: Guidelines for management of colorectal hepatic metastases
Manchester Cancer Colorectal Pathway Board: Guidelines for management of colorectal hepatic metastases Date: April 2015 Date for review: April 2018 1. Principles The recognised specialist HPB MDT for Greater
More informationMANAGEMENT OF COLORECTAL METASTASES. Robert Warren, MD. The Postgraduate Course in General Surgery March 22, /22/2011
MANAGEMENT OF COLORECTAL METASTASES Robert Warren, MD The Postgraduate Course in General Surgery March 22, 2011 Local Systemic LIVER TUMORS:THERAPEUTIC OPTIONS Hepatoma Cholangio. Neuroendo. Colorectal
More informationManagement of colorectal cancer liver metastases
Management of colorectal cancer liver metastases Aliakbarian M. M.D. Assistant professor of surgery Organ Transplant & Hepatopancreatobiliary Surgeon SUBJECTS The importance of surgical resection in colorectal
More informationManagement of Stage IV Colorectal Cancer: Expanding the Horizon
Management of Stage IV Colorectal Cancer: Expanding the Horizon May Tee, MD, MPH and Jan Franko, MD, PhD MercyOne Surgical Group (Mercy Surgical Affiliates) GI Oncology Conference 2019 March 1, 2019 Disclosures
More informationColorectal Liver Metastases Metachronous
Colorectal Liver Metastases Metachronous Professor Rowan Parks Professor of Surgical Sciences University of Edinburgh No disclosures Natural History of Unresected Untreated Colorectal Metastases Year N
More informationPrimary tumor with synchronous metastases
Metastatic colorectal cancer: special clinical situations Primary tumor with synchronous metastases Stefan Heinrich & Hauke Lang Department of General, Visceral and Transplantation Surgery University Hospital
More informationTrattamento chirurgico delle lesioni epatiche secondarie difficili. Adelmo Antonucci Chirurgia Oncologica e Epato-bilio-pancreatica
Trattamento chirurgico delle lesioni epatiche secondarie difficili Adelmo Antonucci Chirurgia Oncologica e Epato-bilio-pancreatica What does it mean difficult lesions? Diagnosis Treatment Small size Unfit
More informationThe Surgical Management of Colorectal Metastases
11th July 2017 Bowel Cancer UK The Surgical Management of Colorectal Metastases Ben Cresswell MD(Res) FRCS Consultant HPB Surgeon The Basingstoke Hepatobiliary Unit United Kingdom Surgical Management of
More informationTreatment strategy of metastatic rectal cancer
35.Schweizerische Koloproktologie-Tagung Treatment strategy of metastatic rectal cancer Gilles Mentha University hospital of Geneva Bern, January 18th, 2014 Colorectal cancer is the third most frequent
More informationManagement of Colorectal Liver Metastases
Management of Colorectal Liver Metastases MM Bernon, JEJ Krige HPB Surgical Unit, Groote Schuur Hospital Department of Surgery, University of Cape Town 50% of patients with colorectal cancer develop liver
More informationTechniques to Improve Resectability of Colorectal Liver Metastases Ching-Wei D. Tzeng, M.D.
Techniques to Improve Resectability of Colorectal Liver Metastases Ching-Wei D. Tzeng, M.D. Department of Surgery Grand Rounds University of Kentucky January 15, 2014 Metastatic Colorectal Cancer (CRC)
More informationState of the art management of Colorectal Liver Metastasis: an interplay of Chemotherapy and Surgical options
State of the art management of Colorectal Liver Metastasis: an interplay of Chemotherapy and Surgical options Ioannis S. Hatzaras, MD, MPH, FACS Assistant Professor of Surgery Division of Surgical Oncology
More informationSurgical Management of Advanced Stage Colon Cancer. Nathan Huber, MD 6/11/14
Surgical Management of Advanced Stage Colon Cancer Nathan Huber, MD 6/11/14 Colon Cancer Overview Approximately 50,000 attributable deaths per year Colorectal cancer is the 3 rd most common cause of cancer-related
More informationGreater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 5
Greater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 5 Contents 5. Assessment & Management of Liver Metastases 42 5.1. Metachronous
More informationResection of liver limited resectable metastases Upfront, neoadjuvant and repeat hepatectomy
Resection of liver limited resectable metastases Upfront, neoadjuvant and repeat hepatectomy Dr Chan Chung Yip MBBS, M.Med(Surgery), MD, FAMS, FRCSEd Senior Consultant and Head Department of Hepatopancreatobiliary
More informationColon Cancer Liver Metastases: Liver-Directed Therapy
Colon Cancer Liver Metastases: Liver-Directed Therapy Shishir K. Maithel, MD FACS Assistant Professor of Surgery Division of Surgical Oncology Winship Cancer Institute Emory University August 10, 2014
More informationState of the Art: Colorectal Cancer Liver Metastasis Dr. Iain Tan
State of the Art: Colorectal Cancer Liver Metastasis Dr. Iain Tan Consultant GI Medical Oncologist National Cancer Centre Singapore Clinician Scientist, Genome Institute of Singapore OS (%) Overall survival
More informationCT PET SCANNING for GIT Malignancies A clinician s perspective
CT PET SCANNING for GIT Malignancies A clinician s perspective Damon Bizos Head, Surgical Gastroenterology Charlotte Maxeke Johannesburg Academic Hospital Case presentation 54 year old with recent onset
More informationCurrent Treatment of Colorectal Metastases. Dr. Thavanathan Surgical Grand Rounds February 1, 2005
Current Treatment of Colorectal Metastases Dr. Thavanathan Surgical Grand Rounds February 1, 2005 25% will have metastases at initial presentation 25-50% 50% will develop metastases later 40% of potentially
More informationCase Report In Situ Split of the Liver When Portal Venous Embolization Fails to Induce Hypertrophy: A Report of Two Cases
Case Reports in Surgery Volume 2013, Article ID 238675, 4 pages http://dx.doi.org/10.1155/2013/238675 Case Report In Situ Split of the Liver When Portal Venous Embolization Fails to Induce Hypertrophy:
More informationAintree University Hospital
Aintree University Hospital Liverpool, UK Evolving role of DEBIRI with DC Bead - TACE in mcrc Hassan Z Malik MD FRCS Consultant Hepatobiliary Surgeon Hassan Z Malik is a consultant to Biocompatibles UK
More informationLiver surgery for colorectal liver metastases. Keith Roberts, Consultant Liver Transplant and Liver/Pancreas Surgeon University Hospitals Birmingham
Liver surgery for colorectal liver metastases Keith Roberts, Consultant Liver Transplant and Liver/Pancreas Surgeon University Hospitals Birmingham Introduction: what do we do? UHB Liver Unit: Liver resections
More informationADJUVANT CHEMOTHERAPY...
Colorectal Pathway Board: Non-Surgical Oncology Guidelines October 2015 Organization» Table of Contents ADJUVANT CHEMOTHERAPY... 2 DUKES C/ TNM STAGE 3... 2 DUKES B/ TNM STAGE 2... 3 LOCALLY ADVANCED
More informationSECONDARIES: A PRELIMINARY REPORT
HPB Surgery, 1990, Vol. 2, pp. 69-72 Reprints available directly from the publisher Photocopying permitted by license only 1990 Harwood Academic Publishers GmbH Printed in the United Kingdom CASE REPORTS
More informationDr. Iain Tan. Senior Consultant GI Medical Oncologist National Cancer Centre Singapore
ESMO-ASIA 2017 Preceptorship (GI cancers) Session: Metastatic colorectal cancer, liver limited metastases Topic: Unresectable or borderline resectable : chemotherapy +/- targeted agents Dr. Iain Tan Senior
More informationJose Ramos. Role of Surgery in isolated hepatic metastasis from breast carcinoma, melanoma or sarcoma
Role of Surgery in isolated hepatic metastasis from breast carcinoma, melanoma or sarcoma Jose Ramos University of the Witwatersrand Donald Gordon Medical Centre Evolution of liver resection Better understanding
More informationLIVER SURGERY 2. Case 1. Med 5 Refresher Course (Surgery) 2013/14. Dr Sunny Cheung
LIVER SURGERY 2 Med 5 Refresher Course (Surgery) 2013/14 24 Jun 2013 Dr Sunny Cheung Case 1 50/M Sudden onset of epigastric pain Abdominal distension Confused HR 120 BP 80/50 Haemocue = 8 What should you
More informationSurgical Management of Pancreatic Cancer
I Congresso de Oncologia D Or July 5-6, 2013 Surgical Management of Pancreatic Cancer Michael A. Choti, MD, MBA, FACS Department of Surgery Johns Hopkins University School of Medicine, Baltimore, MD Estimated
More informationSurgical management of HCC. Evangelos Prassas Hepatobiliary and Pancreatic Surgery / Liver Transplantation Kings College Hospital / London
Surgical management of HCC Evangelos Prassas Hepatobiliary and Pancreatic Surgery / Liver Transplantation Kings College Hospital / London Global distribution of HCC and staging systems WEST 1. Italy (Milan,
More informationPlanned relaparotomy following curative resection of a locally advanced gastrointestinal cancer
Planned relaparotomy following curative resection of a locally advanced gastrointestinal cancer PD Dr. med. Michel Adamina, MSc Department of Surgery Agenda Prerequisite for successful CRS HIPEC Planned
More informationCOLORECTAL CARCINOMA
QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF COLORECTAL CARCINOMA Ministry of Health Malaysia Malaysian Society of Colorectal Surgeons Malaysian Society of Gastroenterology & Hepatology Malaysian
More informationBACKGROUND: STUDY DESIGN: RESULTS: CONCLUSIONS:
Improved Survival after Resection of Liver and Lung Colorectal Metastases Compared with Liver-Only Metastases: A Study of 112 Patients with Limited Lung Metastatic Disease Antoine Brouquet, MD, Jean Nicolas
More informationSTRICTURES OF THE BILE DUCTS Session No.: 5. Andrea Tringali Digestive Endoscopy Unit Catholic University Rome - Italy
STRICTURES OF THE BILE DUCTS Session No.: 5 Andrea Tringali Digestive Endoscopy Unit Catholic University Rome - Italy Drainage of biliary strictures. The history before 1980 Surgical bypass Percutaneous
More informationCOLON AND RECTAL CANCER
COLON AND RECTAL CANCER Mark Sun, MD Clinical Associate Professor of Surgery University of Minnesota No disclosures Objectives 1) Understand the epidemiology, management, and prognosis of colon and rectal
More informationINTRAARTERIAL TREATMENT OF COLORECTAL LIVER METASTASES. Dr. Joan Falcó Interventional Radiology UDIAT. Hospital Universitari Parc Taulí
INTRAARTERIAL TREATMENT OF COLORECTAL LIVER METASTASES Dr. Joan Falcó Interventional Radiology UDIAT. Hospital Universitari Parc Taulí STRATEGIES FOR CRLM LIVER METASTASES Extended indications Resectable
More informationAdvanced Pelvic Malignancy: Defining Resectability Be Aggressive. Lloyd A. Mack September 19, 2015
Advanced Pelvic Malignancy: Defining Resectability Be Aggressive Lloyd A. Mack September 19, 2015 CONFLICT OF INTEREST DECLARATION I have no conflicts of interest Advanced Pelvic Malignancies Locally Advanced
More informationAfternoon Session Cases
Afternoon Session Cases Case 1 19 year old woman Presented with abdominal pain to community hospital Mild incr WBC a14, 000, Hg normal, lipase 100 (normal to 75) US 5.2 x 3.7 x 4 cm mass in porta hepatis
More informationColorectal Cancer and FDG PET/CT
Hybrid imaging in colorectal & esophageal cancer Emmanuel Deshayes IAEA WorkShop, November 2017 Colorectal Cancer and FDG PET/CT 1 Clinical background Cancer of the colon and rectum is one of the most
More informationGhosts in the Machine: Jonathan B. Koea MD; FRACS. Department of Surgery Auckland Hospital Auckland New Zealand
Ghosts in the Machine: Patient Journeys Through Cancer Treatment Jonathan B. Koea MD; FRACS. Department of Surgery Auckland Hospital Auckland New Zealand Age-Standardised Cancer Incidence (100,000 population)
More informationREVIEW ARTICLE. The Liver-First Approach to the Management of Colorectal Cancer With Synchronous Hepatic Metastases
REVIEW ARTICLE The -First Approach to the Management of Colorectal Cancer With Synchronous Hepatic Metastases A Systematic Review Santhalingam Jegatheeswaran, MRCS; James M. Mason, DPhil; Helen C. Hancock,
More informationNEUROENDOCRINE CARCINOID TUMORS PANCREATIC NEUROENDOCRINE TUMORS
University of Miami Jackson Memorial Hospital Role of the Surgeon in the Approach to Neuroendocrine tumors Dido Franceschi, MD Professor of Surgery University of Miami Karzinoide Siegfried Oberndorfer,
More informationWhat you need to know about Radiation Therapy for Colorectal Cancer
What you need to know about Radiation Therapy for Colorectal Cancer Questions and Answers CR Lund MSc MD FRCPC Radiation Oncologist Clinical Assistant Professor Overview I. Description of Radiation II.
More informationOriginal article: new surgical approaches to the Klatskin tumour
Alimentary Pharmacology & Therapeutics Original article: new surgical approaches to the Klatskin tumour T. M. VAN GULIK*, S. DINANT*, O. R. C. BUSCH*, E. A. J. RAUWS, H. OBERTOP* & D. J. GOUMA Departments
More informationTREATMENT OF PERITONEAL COLORECTAL CARCINOMATOSIS
TREATMENT OF PERITONEAL COLORECTAL CARCINOMATOSIS Anna Lepistö, MD, PhD Department of Colorectal Surgery, Abdominal Center, Helsinki University Hospital Incidence, prevalence and risk factors for peritoneal
More informationLaparoscopic Resection Of Colon & Rectal Cancers. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Laparoscopic Resection Of Colon & Rectal Cancers R Sim Centre for Advanced Laparoscopic Surgery, TTSH Feasibility and safety Adequacy - same radical surgery as open op. Efficacy short term benefits and
More informationCarcinoma del colon-retto: La Chirurgia Robotica nella Malattia Avanzata
Carcinoma del colon-retto: La Chirurgia Robotica nella Malattia Avanzata Alberto Patriti SSD Chirurgia Robotica Multidisciplinare ASL 2 Umbria Ospedale San Matteo degli Infermi Spoleto - Why MIS for Advanced
More informationCorrespondence should be addressed to Roland Andersson,
Gastroenterology Research and Practice Volume 2012, Article ID 568214, 4 pages doi:10.1155/2012/568214 Research Article Repeated Liver Resection for Colorectal Liver Metastases: A Comparison with Primary
More informationImage Guidance Improves Localization of Sonographically Occult Colorectal Liver Metastases
Image Guidance Improves Localization of Sonographically Occult Colorectal Liver Metastases Universe Leung a, Amber L. Simpson a,b, Lauryn B. Adams a, William R. Jarnagin a, Michael I. Miga b, and T. Peter
More informationMargin status in liver resections for colorectal metastases Orlando Jorge M. Torres MD, PhD
Margin status in liver resections for colorectal metastases Orlando Jorge M. Torres MD, PhD Full Professor and Chairman Department of Gastrointestinal Surgery Hepatopancreatobiliary Unit Universidade Federal
More informationDisclosure. Acknowledgement. What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Rectal cancer imaging. None
What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Zhen Jane Wang, MD Assistant Professor in Residence UC SF Department of Radiology Disclosure None Acknowledgement Hueylan Chern, MD, Department
More informationCOLON AND RECTAL CANCER
No disclosures COLON AND RECTAL CANCER Mark Sun, MD Clinical Assistant Professor of Surgery University of Minnesota Colon and Rectal Cancer Statistics Overall Incidence 2016 134,490 new cases 8.0% of all
More informationStaging & Current treatment of HCC
Staging & Current treatment of HCC Dr.: Adel El Badrawy Badrawy; ; M.D. Staging & Current ttt of HCC Early stage HCC is typically silent. HCC is often advanced at first manifestation. The selective ttt
More informationStaging Colorectal Cancer
Staging Colorectal Cancer CT is recommended as the initial staging scan for colorectal cancer to assess local extent of the disease and to look for metastases to the liver and/or lung Further imaging for
More informationPhysician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer
Physician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer Gabriela M. Vargas, MD Kristin M. Sheffield, PhD, Abhishek Parmar, MD, Yimei Han, MS, Kimberly M. Brown,
More informationStructured Follow-Up after Colorectal Cancer Resection: Overrated. R. Taylor Ripley University of Colorado Grand Rounds April 23, 2007
Structured Follow-Up after Colorectal Cancer Resection: Overrated R. Taylor Ripley University of Colorado Grand Rounds April 23, 2007 Guidelines for Colonoscopy Production: Surveillance US Multi-Society
More informationTreatment of oligometastatic NSCLC
Treatment of oligometastatic NSCLC Jarosław Kużdżał Department of Thoracic Surgery Jagiellonian University Collegium Medicum, John Paul II Hospital, Cracow New idea? 14 NSCLC patients with solitary extrathoracic
More informationSurgical. Gastroenterology. Evaluating the efficacy of tumor markers CA 19-9 and CEA to predict operability and survival in pancreatic malignancies
Tropical Gastroenterology 2010;31(3):190 194 Surgical Gastroenterology Evaluating the efficacy of tumor markers and CEA to predict operability and survival in pancreatic malignancies Jay Mehta, Ramkrishna
More informationSurgery for hilar cholangiocirconoma
Department of Surgery University Hospital RWTH Aachen Surgery for hilar cholangiocirconoma Ulf Peter Neumann Agenda Operating on the most complex tumor in HBP Surgery Preoperative management Does the patient
More informationUpdate on RECIST and Staging of Common Pediatric Tumors Ethan A. Smith, MD
Update on RECIST and Staging of Common Pediatric Tumors Ethan A. Smith, MD Section of Pediatric Radiology C.S. Mott Children s Hospital University of Michigan ethans@med.umich.edu Disclosures No relevant
More informationLiver surgery, acute GI tract bleeding
Semmelweis University, Faculty of Medicine, 1 st Department of Surgery Liver surgery, acute GI tract bleeding Oszkár HAHN M.D. LIVER CYST US, CT, MRI Parasite (ELISA, eosinophil, anaphylaxy) Echinococcus
More informationRectal cancer management: a team sport The role of radiology and the multidisciplinary conference
Rectal cancer management: a team sport The role of radiology and the multidisciplinary conference W. Donald Buie MD MSc FRCSC Professor of Surgery and Oncology Department of Surgery University of Calgary
More informationHEPATIC METASTASES. We can state 3 types of metastases depending on their treatment options:
HEPATIC METASTASES 1. Definition Metastasis means the spread of cancer. Cancerous cells can separate from the primary tumor and enter the bloodstream or the lymphatic system (the one that produces, stores,
More informationManagement of Liver Metastasis from Colorectal Carcinoma. Aisha White, M.D. SUNY Downstate Division of Transplantation
Management of Liver Metastasis from Colorectal Carcinoma Aisha White, M.D. SUNY Downstate Division of Transplantation Management of Colorectal Liver Metastasis Epidemiology 25% of patients diagnosed
More informationPredictors of a True Complete Response Among Disappearing Liver Metastases From Colorectal Cancer After Chemotherapy
Original Article Predictors of a True Complete Response Among Disappearing Liver Metastases From Colorectal Cancer After Chemotherapy Rebecca C. Auer, MD 1 ; Rebekah R. White, MD 2 ; Nancy E. Kemeny, MD
More informationCOLORECTAL CANCER STAGING in 2010
COLORECTAL CANCER STAGING in 2010 Robert A. Halvorsen, MD, FACR MCV Hospitals / VCU Medical Center Richmond, Virginia I do not have any relevant financial relationships with any commercial interests COLON
More informationBehandeling van colorectale levermetastasen. Rol van beeldvorming van de lever bij colorectaal carcinoom
Behandeling van colorectale levermetastasen Rol van beeldvorming van de lever bij colorectaal carcinoom B. Op de Beeck Universitair Ziekenhuis Antwerpen bart.op.de.beeck@uza.be 10.12.2016 AZ Turnhout campus
More information6 th August 2018 Day 1 - Gallbladder & Bile duct Topic
Venue: Sterling Hospital Auditorium, Sterling Hospitals, Gurukul Road Ahmedabad, Gujarat 6 th August 2018 Day 1 - Gallbladder & Bile duct Registration(8:00am-8:15am) Inauguration(8:15am-8:30am) Welcome
More informationParenchyma saving resectionsfictions. (Colorectal liver metastasis)
Parenchyma saving resectionsfictions or facts? (Colorectal liver metastasis) Bjørn Edwin, professor, MD, PhD Section manager, Clinical Research The Interventional Center and HPB-Department Oslo University
More informationRole of MRI for Staging Rectal Cancer
Role of MRI for Staging Rectal Cancer High-resolution MRI has supplanted endoscopic ultrasound for staging rectal cancer. High-resolution MR images closely match histology and can show details such as
More informationAggressive surgery in the multimodality treatment of liver metastases from colorectal cancer
Journal of BUON 12: 209-213, 2007 2007 Zerbinis Medical Publications. Printed in Greece ORIGINAL ARTICLE Aggressive surgery in the multimodality treatment of liver metastases from colorectal cancer N.
More informationIMAGING GUIDELINES - COLORECTAL CANCER
IMAGING GUIDELINES - COLORECTAL CANCER DIAGNOSIS The majority of colorectal cancers are diagnosed on colonoscopy, with some being diagnosed on Ba enema, ultrasound or CT. STAGING CT chest, abdomen and
More informationMANAGEMENT OF INCIDENTALLY DETECTED GALLBLADDER CANCER
MANAGEMENT OF INCIDENTALLY DETECTED GALLBLADDER CANCER Orlando Jorge M. Torres Full Professor and Chairman Department of Gastrointestinal Surgery Hepatopancreatobiliary Unit Federal University of Maranhão
More informationCOLON CANCER PERITONEAL CARCINOMATOSIS TREATMENT Prof. Annibale Donini
UNIVERSITY OF PERUGIA Department of General and Emergency Surgery Chief: Prof. Annibale Donini COLON CANCER PERITONEAL CARCINOMATOSIS TREATMENT Prof. Annibale Donini COLON CANCER IS A HIGHLY FREQUENT NEOPLASIA
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdominal surgery prior as factor in laparoscopic colorectal surgery, 554 555 Abscess(es) CRC presenting as, 539 540 Adenocarcinoma of
More informationSynchronous Hepatic Cryotherapy and Resection
HPB Surgery, 2000, Vol. 11, pp. 379-382 Reprints available directly from the publisher Photocopying permitted by license only (C) 2000 OPA (Overseas Publishers Association) N.V. Published by license under
More informationLiver resection for HCC
8 th LIVER INTEREST GROUP Annual Meeting Cape Town 2017 Liver resection for HCC Jose Ramos University of the Witwatersrand Donald Gordon Medical Centre The liver is almost unique in that treatment of the
More informationThirty-Day Outcomes of Laparoscopic vs. Open Total Proctocolectomy with Ileoanal Anastomosis in Children
Thirty-Day Outcomes of Laparoscopic vs. Open Total Proctocolectomy with Ileoanal Anastomosis in Children Jeremy D. Kauffman MD, Paul D. Danielson MD, Nicole M. Chandler MD Johns Hopkins All Children s
More informationDO DRAINS HELP OR HURT IN HPB SURGERY? Henry A. Pitt, M.D. Chief Quality Officer Temple University Health System July 23, 2017
DO DRAINS HELP OR HURT IN HPB SURGERY? Henry A. Pitt, M.D. Chief Quality Officer Temple University Health System July 23, 217 DISCLOSURES Henry A. Pitt has nothing to disclose Leader of the ACS-NSQIP HPB
More informationDr Adam Bartlett. General Surgeon Senior Lecturer University of Auckland Auckland City Hospital
Dr Adam Bartlett General Surgeon Senior Lecturer University of Auckland Auckland City Hospital 11:05-11:15 Hepatic Metastectomy is Associated with Improved Survival Where is everyone? Hepatic Metastectomy
More informationRepeated Liver Resection for Colorectal Liver Metastases: A Comparison with Primary Liver Resections concerning Perioperative and Long-Term Outcome.
Repeated Liver Resection for Colorectal Liver Metastases: A Comparison with Primary Liver Resections concerning Perioperative and Long-Term Outcome. Jönsson, Kristoffer; Gröndahl, Gerd; Salö, Martin; Tingstedt,
More informationTIMOTHY M. PAWLIK, RICHARD D. SCHULICK, MICHAEL A. CHOTI
The Oncologist Hepatobiliary Expanding Criteria for Resectability of Colorectal Liver Metastases TIMOTHY M. PAWLIK,RICHARD D. SCHULICK,MICHAEL A. CHOTI Department of Surgery, Johns Hopkins University School
More informationFollow up The way ahead. John Griffith
Follow up The way ahead John Griffith Key Emerging Principles Risk stratified pathways of care Personalised care plan and treatment summary with a hand held record Information and education Remote monitoring
More informationBY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY
BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY Cancer is a group of more than 100 different diseases that are characterized by uncontrolled cellular growth,
More informationHEPATECTOMY. Surgical Potpourri Session. ACS NSQIP National Conference Salt Lake City 2012
HEPATECTOMY Surgical Potpourri Session ACS NSQIP National Conference Salt Lake City 2012 Pascal Fuchshuber, MD, PhD, FACS Kaiser Permanente Medical Center Walnut Creek - California Hepatic Resection Is
More informationUpper GI Malignancies Imaging Guidelines for the Management of Gastric, Oesophageal & Pancreatic Cancers 2012
Upper GI Malignancies Imaging Guidelines for the Management of Gastric, Oesophageal & Pancreatic Cancers 2012 Version Control This is a controlled document please destroy all previous versions on receipt
More informationEvolution of Surgery: Role of the Surgeon in the Molecular and Technology Age. Yuman Fong, MD Memorial Sloan-Kettering Cancer Center Rio 2010
Evolution of Surgery: Role of the Surgeon in the Molecular and Technology Age Yuman Fong, MD Memorial Sloan-Kettering Cancer Center Rio 2010 Molecular mechanisms for cancer Prevention and screening Molecular
More informationRadiotherapy for Rectal Cancer. Kevin Palumbo Adelaide Radiotherapy Centre
Radiotherapy for Rectal Cancer Kevin Palumbo Adelaide Radiotherapy Centre Overview CRC are common (3 rd commonest cancer) rectal Ca approx 25-30% of all CRC. Presentation PR bleeding: beware attributing
More informationPatient Presentation. 32 y.o. female complains of lower abdominal mass CEA = 433, CA125 = 201
Patient Presentation 32 y.o. female complains of lower abdominal mass CEA = 433, CA125 = 201 CT shows: Thickening of the right hemidiaphragm CT shows: Fluid in the right paracolic sulcus CT shows: Large
More informationHIPEC Controversies in the Indications and Application of Regional Chemotherapy for Peritoneal Surface Malignancies
HIPEC Controversies in the Indications and Application of Regional Chemotherapy for Peritoneal Surface Malignancies Crescent City Cancer Update: GI and HPB Saturday September 24, 2016 George M. Fuhrman,
More informationUpdate in abdominal Surgery in cirrhotic patients
Update in abdominal Surgery in cirrhotic patients Safi Dokmak HBP department and liver transplantation Beaujon Hospital, Clichy, France Cairo, 5 April 2016 Cirrhosis Prevalence in France (1%)* Patients
More informationNewcastle HPB MDM updated radiology imaging protocol recommendations. Author Dr John Scott. Consultant Radiologist Freeman Hospital
Newcastle HPB MDM updated radiology imaging protocol recommendations Author Dr John Scott. Consultant Radiologist Freeman Hospital This document is intended as a guide to aid radiologists and clinicians
More informationP R O G R A M. 08:50 09:10 Present and future of surgery of pancreatic cancer: how far can we go?
P R O G R A M Course Day 1, Friday November 2, 2018 08:30 08:00 Official Opening Welcome Address 08:30 08:35 08:35 08:40 08:40 08:45 08:45 08:50 Jakob Izbicki (Germany), EFISDS President T. Seufferlein
More informationLaparoscopic combined colorectal and liver resections for primary colorectal cancer with synchronous liver metastases
Ann Hepatobiliary Pancreat Surg 2016;20:167-172 https://doi.org/10.14701/ahbps.2016.20.4.167 Original Article Laparoscopic combined colorectal and liver resections for primary colorectal cancer with synchronous
More informationCOMPARING Y90 DEVICES
COMPARING Y90 DEVICES William S Rilling MD, FSIR Professor of Radiology and Surgery Director, Vascular and Interventional Radiology Medical College of Wisconsin DISCLOSURES Research support : Siemens,
More informationOutcome of rectal cancer after radiotherapy with a long or short waiting period before surgery, a descriptive clinical study
Original Article Outcome of rectal cancer after radiotherapy with a long or short waiting period before surgery, a descriptive clinical study Elmer E. van Eeghen 1, Frank den Boer 2, Sandra D. Bakker 1,
More informationIntroduction. Case Report
Case Report A patient who showed a pathologically complete response after undergoing treatment with XELOX plus bevacizumab for synchronous liver metastasis of grade H2 from sigmoid colon cancer Yasuhito
More informationTitle: What is the role of pre-operative PET/PET-CT in the management of patients with
Title: What is the role of pre-operative PET/PET-CT in the management of patients with potentially resectable colorectal cancer liver metastasis? Pablo E. Serrano, Julian F. Daza, Natalie M. Solis June
More information