The incidence of colorectal cancer increased yearly,and more than 50％ patients had liver metastases.As continuous development of recognition and treatment of colorectal liver metastases,it now has been reckoned as a potentially curable disease,and its prognosis has been improved significantly.However,how to choose the reasonable treatment is a problem for us.The standardized treatment of colorectal liver metastases should include imaging examination,surgical treatment and multi-disciplinary treatment,and individualized treatment should be considered.In this article,the selection of proper imaging examination,comparison of different treatment methods,surgical treatment of liver metastases and multi-disciplinary treatment are discussed.

Surgical resection is currently the only cure treatment for colorectal carcinoma liver metastasis (CRLM). The efficien-cy of surgical resection has improved with the development of systemic chemotherapy and targeted drugs and the application of hepatic arterial infusion chemotherapy in recent years. The number of patients benefiting from surgery has gradually increased. The progression of surgical techniques such as radiofrequency ablation and staged hepatectomy provides chances of cure for patients with CRLM. Multi-disciplinary team creates the opportunity of individual diagnosis and treatment for growing number of patients with CRLM, which, in turn, promotes the treatment of CRLM to a more precise future.

Objective To evaluate the results of surgical treatment for duodenal gastrointestinal stromal tumor (GIST).Methods Between January 2000 and January 2013,33 patients underwent surgical resection of duodenal GIST in Peking University Cancer Hospital,including local resection and pancreatoduodenectomy.Clinical data,surgical outcome and prognosis were reviewed.Results The median survival time is 94 months (range:55-132 months).The 1,3,5-year survival rates are 97％,89％ and 80％,respectively.The 5 year survival rate of patients after pancreatoduodenectomy and local resection is 78％ and 83％,respectively (P =0.091).It shows that tumor size and mitotic count and Fletcher classification influence overall survival.Conclusions When fulfiling proper safe margins,local resection is a reliable and curative option for most duodenal GISTs.

Biomedical Research ; trends ; Colorectal Neoplasms ; pathology ; Humans ; Liver Neoplasms ; secondary

Objective To investigate the expression of cyclooxygenase-2 in hepatocelluar carcinoma cell lines. Methods RT-PCR and immunocytochemistry were use d to investigate the expression of cyclooxygenase-2 in 6 hepatocellular carcino ma cell lines. Result COX-2 mRNA expression was detected in five of six cell lines, and all six cell lines w ere positive for COX-2 protein expression. Conclusion COX-2 is expressed in hepatocellular carcinoma cell li nes, providing basis for the chemoprevention of hepatocelluar carcinoma.

Objective To investigate survival for primary duodenal carcinoma patients after radical resection and identify risk factors associated with overall survival.Methods Data of 51 patients with primary duodenal carcinomas who underwent radical resection between December 2003 and December 2012 at Beijing Cancer Hospital were included.Survival analysis was drawn by Kaplan-Meier method,univariate and multivariate analyses were performed to identify variables associated with survival after resection by COX regression model.Results The median overall survival time was 67 months,and the median disease-free time was 40 months,1-,2-and 3-year overall survival rates were 88％,84％ and 67％,respectively.Multivariate analysis revealed that regional lymph-node positive (P =0.032) and CA199 ＞ 37 U/ml (P =0.037) were independent risk factors of patients' overall survival.Conclusions Radical resection improves survival for primary duodenal carcinoma patients.Regional lymph-node positive and CA199 ＞37 U/ml were the most important risk factors of patients'overall survival.

Objective Bisegmentectomy Ⅶ-Ⅷ can be an alternative option for the tumor localized in segments Ⅶ and Ⅷ and infiltrating the main trunk of RHV instead of a right hemihepatectomy.This study was to evaluate the safety and practicability of the removal of segments Ⅶ and Ⅷ of the liver with the resection of the main trunk of RHV without vascular reconstruction.Method 13 consecutive patients underwent bisegmentectomy Ⅶ-Ⅷ with the resection of the RHV between Nov.2006 and Dec.2012 at Beijing Cancer Hospital 1st Department.of HPB Surgery.Results Bisegmentectomy Ⅶ-Ⅷ with the resection of the RHV was performed in all 13 patients successfully without the distal vein reconstruction.The duration of the operations was 90-215 min.Mean blood loss was estimated to be 200 ml (100-700 ml).Indications for a bisegmentectomy Ⅶ-Ⅷ included hepatocellular carcinoma in 6 cases,intrahepatic cholangiocarcinoma in one,liver metastasis in 4 and hepatic hemangioma in 2 as confirmed pathologically.All patients recovered without severe complications.The atrophy of segment Ⅵ due to the venous drainage obstacle was observed in 3 patients without the dysfunction of liver postoperatively.Conclusions It is safe and practicable to perform Ⅶ and Ⅷ bisegmentectomy with resection of the right hepatic vein without vascular reconstruction for liver tumors.

Objective To study the survival outcome and the survival-related factors in patients who received liver resection for multiple (≥4) liver metastases of colorectal cancer.Method The results for patients who received partial hepatectomy for four or more colorectal hepatic metastases carried out in the 1 st Department of HPB Surgery,Peking University Cancer Hospital were studied retrospectively.Results Between 2002 and 2013,of 239 patients,60 patients with four or more colorectal hepatic metastases received partial hepatectomy.The median overall survival was 35.2 months and the 5-year survival was 28.2％ (17/60).There were two actuarial 5-year survivors.The median disease-free survival was 6.9 months,with 1 actuarial disease-free survivor at 5 years.There were no perioperative deaths,and the perioperative morbidity was 36.7％ (22/60).Major (hemi-liver or more) liver resection and 7 or more metastases were independently associated with poor survival outcome.Perineural Invasion (T4) of the primary tumor,size of the largest metastasis (≥4 cm),neoadjuvant chemotherapy,and resection of recurrent disease were also associated with survival outcome.Conclusions Long-term survival could be achieved after resection of multiple colorectal liver metastases.Minor resection for multiple colorectal metastases was superior in survival compared with major resection.Additional survival advantage could be achieved by resection of recurrent disease.

Objective To evaluate the correlation between postoperative complications and prognosis after radical hepatic resection for colorectal liver metastasis (CRLM).Methods We retrospectively summarized patients' clinicopathological data and postoperative complications.Postoperative complications were graded using Dindo-Clavien system of classification.Then we investigate the relation between these data and prognosis.Results One hundred and seventy-three patients were recruited.Postoperative complications developed in 59 (34.1％) cases.37 patients had minor complications and 22 patients had major complications.On univariate (x2 =8.106,P =0.004) and multivariate analysis (x2 =8.006,P =0.005),complication was an independent predictor of overall survival (OS).However,in a subgroup of patients with minor compications,morbidity was not associated with a significant reduction in both OS (x2 =3.199,P =0.074) and disease-free survival (x2 =1.313,P =0.252).Conclusions Postoperative complications are an independent factor for long-term outcomes after hepatic resection for CRLM.

Objective To identify the risk factors associated with overall survival (OS) for patients undergoing partial hepatectomy for colorectal liver metastases,and to assess the predictive values of five published scoring systems in an independent patient cohort for the purpose of external validation.Methods The clinical,pathologic,and complete follow-up data were prospectively collected from 303 consecutive patients who underwent primary hepatic resection for colorectal liver metastases at the Beijing Cancer Hospital from January 2000 to Aug 2014.The predictive values of the Nordlinger score,the Memorial Sloan-Kettering Cancer Center (MSKCC) score,the Iwatsuki score,the Basingstoke index,and the Konopke scoring system were assessed in this patient set.The clinical and pathologic parameters were further analyzed using univariate and multivariate analyses.Results The 1-,3-and 5-year overall survival were 89.2％,50.8％ and 38.6％,respectively.The median survival time was 37 months.Two risk factors were found to be independent predictors of poor overall survival:the N stage of the primary tumor,and a carcinoembyonic antigen level ＞ 30 μg/L.The MSKCC score had the best independent predictive power for survival when compared with the other 4 prognostic systems (C-index:0.903).Conclusion In our patient cohort,the MSKCC score was the best staging system in predicting survival.