Colorectal Neoplasms ; pathology ; surgery ; Humans ; Liver Neoplasms ; secondary ; surgery

OBJECTIVETo evaluate the safety of simultaneous and staged resection for synchronous liver metastasis from colorectal cancer.

METHODSPubMed/Medline, ISI Web of Knowledge, Springer link, ebscohost, Elsevier Wiley Interscience, Google Scholar were searched for case-control studies concerning simultaneous versus staged resection of synchronous liver metastasis from colorectal cancer between January 1989 and March 2009. A meta-analysis was performed to analyze the morbidity and perioperative mortality.

RESULTSSeven case-control studies, with a total of 1390 patients of liver metastasis from colorectal cancer undergone curative hepatic resection, were reviewed. There were 495 simultaneous and 895 staged resections. Perioperative mortality was 1.1% in the staged resection group and 2.4% in the the simultaneous group, the difference was statistically significant[Peto OR 3.39, 95% CI 1.29-8.93, P=0.01]. No significant difference was found in morbidity between two groups[OR(random)0.88, 95% CI 0.51-1.51, P=0.64].

CONCLUSIONSelective staged resection is safe for synchronous liver metastasis from colorectal cancer.

Colorectal Neoplasms ; pathology ; surgery ; Hepatectomy ; Humans ; Liver Neoplasms ; secondary ; surgery ; Neoplasm Staging

Colorectal Neoplasms ; pathology ; surgery ; Humans ; Liver Neoplasms ; secondary ; surgery ; Neck Dissection

A variety of managements, including systemic and local chemotherapy, radiofrequency ablation and others, are used after multidisciplinary team discussion to improve the survival of patients with unresectable liver metastasis, and to enlarge the cohort of patients who can be managed with curative intent. Patients should be divided into different clinical groups according to characteristics of the patient and tumor, and then receive different treatments. For the patients who may be converted to be resectable after chemotherapy, we should choose efficient convertible chemotherapy with short courses to get the best response rate. For KRAS wild-type patients, cetuximab combined with FOLFOX/FOLFIRI, in which 5-fluorouracil is continuously infused, is recommended. In addition, resection of the primary tumor is recommended at the right time for asymptomatic patients with unresectable liver metastases. There is no consensus on the preferred treatment modality for systemic and local therapies.
Colorectal Neoplasms ; drug therapy ; pathology ; surgery ; therapy ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; surgery

OBJECTIVETo investigate the surgical treatment of ovarian metastasis from colorectal cancer.

METHODSThe clinical data of 62 cases suffering from ovarian metastasis from colorectal cancer, collected from Jan. 1990 to Dec. 2005, were analyzed retrospectively.

RESULTSThe median survival time of 62 colorectal cancer patients with ovarian metastasis was 23 months. The median survival time of 19 patients with simple ovary metastasis was 31 months, while that of 43 patients with ovary and other organ metastasis was 21 months. The median survival time of 28 patients (45.2%) treated with radical resection was 31 months, while that of 34 patients (52.8%) treated with palliative resection was 20 months, the difference between two groups was significant. Fifty-one patients (82.3%) were treated with double-sided ovarian resection, and 42 of them (17.7%) received hysterectomies at the same time. Eleven patients received one-sided ovarian resection, and 8 of them were resected the metastatic ovaries on the other side in 3 to 10 months.

CONCLUSIONSThe patients with ovarian metastases from colorectal cancer need double-sided ovarian resection, and radical resection is able to prolong the survival time.

Adult ; Aged ; Colorectal Neoplasms ; pathology ; surgery ; Female ; Humans ; Middle Aged ; Ovarian Neoplasms ; secondary ; surgery ; Retrospective Studies

INTRODUCTIONMetastatic disease to the liver in colorectal cancer is a common entity that may present synchronously or metachronously. While increasing surgical experience has improved survival outcomes, some evidence suggest that synchronous lesions should be managed differently. This review aims to update current literature on differences between the outcomes and management of synchronous and metachronous disease.

MATERIALS AND METHODSSystematic review of MEDLINE database up till November 2008.

RESULTSDiscrete differences in tumour biology have been identified in separate studies. Twenty-one articles comparing outcomes were reviewed. Definitions of metachronicity varied from anytime after primary tumour evaluation to 1 year after surgery for primary tumour. Most studies reported that synchronous lesions were associated with poorer survival rates (8% to 16% reduction over 5 years). Sixteen articles comparing combined vs staged resections for synchronous tumour showed comparable morbidity and mortality. Benefits over staged resections included shorter hospital stays and earlier initiation of chemotherapy. Suitability for combined resection depended on patient age and constitution, primary tumour characteristics, size and the number of liver metastases, and the extent of liver involvement.

CONCLUSIONSSurgery remains the only treatment option that offers a chance of long-term survival for patients amenable to curative resection. Synchronicity suggests more aggressive disease although a unifying theory for biological differences explaining the disparity in tumour behaviour has not been found. Combined resection of primary tumour and synchronous metastases is a viable option pending careful patient selection and institutional experience. Given the current evidence, management of synchronous and metachronous colorectal liver metastases needs to be individualised to the needs of each patient.

Biomarkers, Tumor ; Colorectal Neoplasms ; mortality ; pathology ; surgery ; Humans ; Liver Neoplasms ; mortality ; secondary ; surgery ; Neoplasms, Multiple Primary ; mortality ; pathology ; surgery ; Neoplasms, Second Primary ; mortality ; pathology ; surgery ; Prognosis

Isolated splenic metastasis arising from colorectal carcinoma is very rare and there has been only 6 cases reported in the English literature. A new case is esented, and its possible pathogenesis was considered with previously reported ses. A 65-year-old male patient had received a right hemicolectomy for cending colon cancer 36 months earlier. He was followed up regularly with rial measurement of serum carcinoembryonic antigen (CEA). Rising serum CEA was scovered from 33 months postoperatively and CT revealed an isolated splenic tastasis. He therefore underwent splenectomy, which was proven to be a tastatic adenocarcinoma with similar histological feature to the original mor. As all reported cases showed elevated serum CEA at the time of tastasis, isolated splenic metastasis might be associated with CEA in regard its biological functions of immunosuppression and adhesion.
Adenocarcinoma/surgery ; Adenocarcinoma/secondary* ; Adenocarcinoma/pathology ; Adenocarcinoma/blood ; Aged ; Carcinoembryonic Antigen/blood ; Case Report ; Colorectal Neoplasms/surgery ; Colorectal Neoplasms/pathology* ; Colorectal Neoplasms/blood ; Human ; Male ; Splenic Neoplasms/surgery ; Splenic Neoplasms/secondary* ; Splenic Neoplasms/blood ; Tomography Scanners, X-Ray Computed

The objective of this study was to conduct a meta-analysis to determine risk factors that may facilitate patient selection for radical resections or additional resections after a polypectomy. Eligible articles were identified by searches of PUBMED, Cochrane Library and Korean Medical Database using the terms (early colorectal carcinoma [ECC], lymph node metastasis [LNM], colectomy, endoscopic resection). Thirteen cohort studies of 7,066 ECC patients who only underwent radical surgery have been analysed. There was a significant risk of LNM when they had submucosal invasion (> or = SM2 or > or = 1,000 microm) (odds Ratio [OR], 3.00; 95% confidence interval [CI], 1.36-6.62, P = 0.007). Moreover, it has been found that vascular invasion (OR, 2.70; 95% CI, 1.95-3.74; P < 0.001), lymphatic invasion (OR, 6.91; 95% CI, 5.40-8.85; P < 0.001), poorly differentiated carcinomas (OR, 8.27; 95% CI, 4.67-14.66; P < 0.001) and tumor budding (OR, 4.59; 95% CI, 3.44-6.13; P < 0.001) were significantly associated with LNM. Furthermore, another analysis was carried out on eight cohort studies of 310 patients who underwent additional surgeries after an endoscopic resection. The major factors identified in these studies include lymphovascular invasion on polypectomy specimens (OR, 5.47; 95% CI, 2.46-12.17; P < 0.001) and poorly or moderately differentiated carcinomas (OR, 4.07; 95% CI, 1.08-15.33; P = 0.04). For ECC patients with > or = SM2 or > or = 1,000 microm submucosal invasion, vascular invasion, lymphatic invasion, poorly differentiated carcinomas or tumor budding, it is deemed that a more extensive resection accompanied by a lymph node dissection is necessary. Even if the lesion is completely removed by an endoscopic resection, an additional surgical resection should be considered in patients with poorly or moderately differentiated carcinomas or lymphovascular invasion.
Colectomy ; Colorectal Neoplasms/*pathology/surgery ; Endoscopy ; Female ; Humans ; Intestinal Polyps/surgery ; Lymphatic Metastasis ; Male ; Neoplasm Invasiveness

Sentinel lymph node biopsy has been found to be highly effective in correctly predicting the nodal status of melanoma and breast cancer patients. Recently, individualized surgical treatments based on the actual metastatic status have been introduced in patients with melanoma and breast cancer. Although several promising results of extensive lymph node dissection have been reported in the field of gastrointestinal (GI) cancer, prognostic benefits of extensive surgery are still not validated by prospective randomized trials. Many feasibility studies favoring sentinel node biopsy in various organs have been reported. Although more evidence from large-scale multicenter clinical trials is required, sentinel lymph node mapping might be also widely acceptable for GI cancer.
Colorectal Neoplasms/surgery ; Esophageal Neoplasms/surgery ; Gastrointestinal Neoplasms/pathology/*surgery ; Humans ; Sentinel Lymph Node Biopsy/*methods ; Stomach Neoplasms/pathology/surgery ; Surgical Procedures, Minimally Invasive/methods

With the development of minimal invasive surgery including laparoscopic and robot surgery, colonoscopic tattooing of colonic lesions is becoming more important to ensure easy localization of the lesion during surgery. Lack of accurate lesion identification during minimal invasive surgery may lead to resection of wrong segment of the bowel. In this article, some topics including proper materials, injection technique, and safety of colonoscopic tattooing are reviewed.
Colon/*pathology ; Colorectal Neoplasms/diagnosis/pathology/surgery ; Humans ; Laparoscopy ; Preoperative Care ; *Tattooing/standards