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

OBJECTIVETo evaluate the survival rate after pulmonary resection for metastatic colorectal cancer(CRC).

METHODSClinical data of 77 patients with pulmonary metastasis from CRC between January 2005 and October 2008 in the Zhongshan Hospital, Fudan University were retrospectively analyzed.

RESULTSThere were 38 patients with synchronous pulmonary metastasis, of whom 2 underwent resection for pulmonary metastasis. The median survival time of two groups was 25 months and 18 months, which was not significantly different (P=0.33). There were 39 cases of metachronous pulmonary metastasis, of whom 28 received pulmonary metastasis resection. The 1-year and 3-year survival rates of 2 groups were 93.3% and 58.5%, and 38.8% and 19.1%, respectively. The median survival time of two groups was 26.7 months and 8 months, and the difference was statistically significant (P=0.004).

CONCLUSIONSurgical resection can improve the survival rate in patients with pulmonary metastasis from colorectal cancer.

Colorectal Neoplasms ; mortality ; pathology ; surgery ; Female ; Humans ; Lung Neoplasms ; mortality ; secondary ; surgery ; Middle Aged ; Neoplasm Metastasis ; Retrospective Studies ; Treatment Outcome

Colectomy ; methods ; Colorectal Neoplasms ; mortality ; pathology ; surgery ; Humans ; Laparoscopy ; Treatment Outcome

BACKGROUNDPrevious studies have shown conflicting results on the relation between clinicopathologic features and prognosis of patients with colorectal mucinous, signet-ring cell, or non-mucinous adenocarcinoma; only few such studies have been performed in China. This retrospective study analyzed data from our department to investigate clinicopathologic characteristics, prognosis and possible correlations of three histologic types - colorectal mucinous, signet-ring cell, and non-mucinous adenocarcinoma, to clarify the bases for observed differences which may lead to development of targeted therapies.

METHODSOf 2079 patients diagnosed with colorectal cancer between 1994 and 2007, 144 had mucinous, 25 had signet-ring cell, and 1837 had non-mucinous adenocarcinoma. Their clinicopathologic parameters and survival were analyzed using established statistical methodologies.

RESULTSMucinous and signet-ring cell adenocarcinomas were common in younger patients (P < 0.001). Location, size and disease stage differed significantly among the three types. Signet-ring cell tumors were more commonly found in the rectum than mucinous and non-mucinous adenocarcinoma (P < 0.001). Mucinous and signet-ring cell tumors presented in a later stage in life more often than non-mucinous adenocarcinoma, with lymph node involvement, serosal infiltration, peritoneal dissemination, and adjacent organ invasion (P < 0.01). The rate of radical resection, hepatic metastasis and local recurrence did not differ among types (P > 0.05). Compared with patients with non-mucinous adenocarcinoma, patients with mucinous and signet-ring cell tumors who underwent potentially curative resections or stage II/III disease had poorer long-term overall survival. Survival did not differ by type for patients with either stage I or IV disease (P > 0.05).

CONCLUSIONSMucinous and signet-ring cell adenocarcinoma have unique carcinogenesis and similar biologic behavior. Our study confirms that both histologic types, especially signet-ring cell tumors, are independent, negative prognostic factors for patients with colorectal cancer. Type does not appear to have a significant effect on survival when disease is either stage I or IV at presentation.

Adenocarcinoma, Mucinous ; mortality ; pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Signet Ring Cell ; mortality ; pathology ; Colorectal Neoplasms ; mortality ; pathology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging

OBJECTIVETo investigate the clinicopathological characteristics and prognosis of patients with recurrent colorectal cancer.

METHODSClinicopathological characteristics and postoperative survival of 235 patients with recurrent colorectal cancer after radical resection were retrospectively analyzed, and was compared with that of 993 patients with radical resection.

RESULTSThe overall 5- and 10-year survival rates after radical resection were 67.7% and 55.8%, respectively. The 5- and 10-year survival rates in patients with recurrent colorectal cancer was 43.9% and 28.1% (P=0.000), respectively. Among patients with recurrent colorectal cancer, the 5- and 10-year survival rates of the patients underwent second radical resection were 50.2% and 32.7%, while the 5- and 10-year survival rates of the patients without second surgery were 25.8% and 0, respectively (P=0.000). On univariate analysis, postoperative recurrence was associated with age at diagnosis, cancerous ileus, ascites, lymphs nodes involvement, gross types, infiltration of tumor and Duke's stage. Multivariate analysis revealed that cancerous ileus, ascites, gross types and Duke's stage were independent predictive factors for postoperative recurrence.

CONCLUSIONCancerous ileus, ascites, gross types and Duke's stage were independent predictive factors for recurrence and metastasis of colorectal cancer after radical resection. The 5- and 10-year survival rates and quality of life could be improved by second radical resection.

Adult ; Aged ; Colorectal Neoplasms ; diagnosis ; mortality ; pathology ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; mortality ; pathology ; Neoplasm Staging ; Prognosis ; Survival Rate

OBJECTIVETo elucidate an adequate hepatectomy margin for simultaneous liver and colorectal resection in colorectal cancer liver metastasis.

METHODSClinical data of 39 patients, undergone simultaneous liver and colorectal resection for colorectal cancer liver metastasis from August 1994 to December 2004, were analyzed retrospectively. Two groups were divided according to the width of hepatectomy margin:less than 1 cm in group A, and equal or more than 1 cm in group B. The data were analyzed and compared between the 2 groups using Kaplan-Meier survival analysis and Log-rank test.

RESULTSThere were 14 patients in group A and 25 patients in group B. No significant differences in gender, age, primary tumor invasion, lymph node metastasis, the number, distribution and size of liver metastasis, duration and blood lose of surgery were found between two groups. The median survival time was 17 months in group A, and 37 months in group B, and the overall 5-year survival rate in group B was much better than that in group A (19.8% vs 0, P<0.01).

CONCLUSIONSimultaneous liver and colorectal resection in colorectal cancer liver metastasis should be performed with a hepatectomy margin equal or more than 1 cm.

Colorectal Neoplasms ; pathology ; Female ; Hepatectomy ; mortality ; Humans ; Liver ; pathology ; surgery ; Liver Neoplasms ; pathology ; secondary ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate

OBJECTIVEThe aim of this study was to analyze the clinical features and prognostic factors in patients with brain metastasis from colorectal cancer (CRC).

METHODSClinical materials of 45 colorectal cancer patients who developed brain metastasis were collected, and the data and follow-up data of those patients were retrospectively analyzed.

RESULTSMost brain metastases were from rectal cancer (64.4%), and 80.0% of the 45 cases had extracranial metastases. The most common extracranial metastatic site was the lung (57.8%), followed by the liver (35.6%). All the brain metastases in patients with liver metastases were supratentorial, while in contrast, 44.8% of the patients without liver metastasis had subtentorial metastasis, showing a significant difference between them (P<0.05). The interval time from diagnosis of CRC to the development of brain metastases in case of Dukes D stage was 12.0 months, significantly shorter than that in the cases of Dukes A stage (24.0 months), B (36.0 months) and C (29.0 months) (P<0.05). The interval time was also shorter in the patients who developed extracranial metastasis within one year than those more than one year (12.0 months vs. 38.0 months)( P<0.05). The median survival time of patients with brain metastasis from colorectal was 6.0 months, with a 1-year survival rate of 21.1% and 2-year survival rate of 3.3% only. Univariate analysis showed that the median survival of patients with a KPS score of ≥70 was 8.0 months, significantly higher than 2.0 months in those with a KPS score of <70 (P<0.05). The median survival of patients with one or two brain metastases was 8.0 months, significantly higher than 4.0 months of those with >2 brain metastases (P<0.05). The median survival time after diagnosis of brain metastasis was 4.0 months for those who received monotherapy (only steroids, only chemotherapy or only radiotherapy), significantly shorter than 10.0 months of patients who received chemoradiotherapy, and 12.0 months of those who underwent surgery (P<0.05). Comparing each two differently treated groups, the survival time of surgery combined with chemotherapy or radiotherapy group was significantly different from that of all of other groups (P<0.05). The median survival time of chemoradiotherapy group was longer than that of monotherapy, but the difference was not significant (P>0.05). Multivariate analysis showed that brain metastases >2 and treatment modality type are independent prognostic factors for survival.

CONCLUSIONSPatients initially diagnosed with a Dukes D stage primary colorectal tumor and occurrence of extracranial metastasis (especially, pulmonary metastasis) within one year are associated to an increased risk of brain metastases and have a shorter survival time. Most brain metastases in patients with liver metastases are supratentorial, while many patients without liver metastasis have subtentorial metastasis. Brain metastases >2 and the type of treatment modality are independent prognostic factors for survival. The prognosis of patients who received chemoradiotherapy is better than those treated only with chemotherapy or radiotherapy. Some subsets of patients may benefit from surgery plus chemotherapy/radiotherapy.

Brain Neoplasms ; mortality ; secondary ; therapy ; Chemoradiotherapy ; Colorectal Neoplasms ; Humans ; Liver Neoplasms ; secondary ; Lung Neoplasms ; secondary ; Neoplasm Staging ; Prognosis ; Rectal Neoplasms ; pathology ; Retrospective Studies ; Survival Rate ; Time Factors

OBJECTIVETo elucidate the efficacy and probable prognostic factors of surgical resection of pulmonary metastasis from colorectal cancer.

METHODSClinical data and outcomes of 35 colorectal patients with pulmonary metastasis undergone pulmonary metastasectomy were analyzed retrospectively.

RESULTSMedian follow-up time was 48.0 months. The median overall survival time was 36.0 months. Five-year survival rate was 33.0%. Nineteen patients died of tumor progression. Sixteen patients were survival including survival with tumor (10 cases) and without tumor (6 cases). One patient was still alive without tumor for 164 months. Univariate analysis revealed that disease free interval (DFI) was a prognostic risk factor, while gender, age, primary tumor site, pulmonary metastasis size and location, surgical procedure, pre-surgical CEA level, re-metastasectomy did not show influence on the survival time after pulmonary metastasectomy.

CONCLUSIONSFor some selected patients with indication, pulmonary metastasectomy may be a potential curative method. DFI may be associated with the prognosis after pulmonary metastasectomy.

Colorectal Neoplasms ; mortality ; pathology ; surgery ; Female ; Humans ; Lung Neoplasms ; mortality ; secondary ; surgery ; Male ; Middle Aged ; Pneumonectomy ; Prognosis ; Retrospective Studies ; Survival Rate ; Treatment Outcome

OBJECTIVESTo analyze the survival outcomes of the surgery for colorectal cancer with liver metastases (CRCLM), and study the mode of multi-disciplinary team (MDT) for CRCLM.

METHODSThe retrospective analysis was conducted for 38 patients with CRCLM received MDT management and surgical treatment from January 2009 to August 2011. The peri-operative and survival outcomes of MDT and surgery were evaluated.

RESULTSAll the cases met the present criteria of resetability for CRCLM, but only 4 cases (10.5%) met the previous one. Coloproctectomy and hepatectomy were performed in all cases, with 39 colorectal neoplasms and 155 liver lesions removed. One case died of postoperative septic shock. Colorectal and hepatic specific complications were absent in the others patients except one case of biliary leak which was treated with conservative management. Neoadjuvant chemotherapy was arranged in 13 cases. Adjuvant chemotherapy was administered for every patient. After a mean follow-up of (22 ± 10) months according to the finding time of liver metastases, recurrence and metastases were observed in 16 cases and 6 cases died of late-stage cachexia. The 1-, 2- and 3-overall survival rate were 94.4%, 85.3% and 75.8% respectively, and the 1-, 2- and 3-disease-free survival rate were 70.1%, 54.2% and 54.2% respectively.

CONCLUSIONSMDT mode for resectable CRCLM is recommendable. Surgical resection of CRCLM is feasible and safe, which seems to achieve favourable short-middle oncologic outcomes. And long-term survival is expected.

Adult ; Aged ; Chemotherapy, Adjuvant ; Colorectal Neoplasms ; mortality ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; mortality ; secondary ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Treatment Outcome

OBJECTIVESTo summarize the clinical experience of preoperative intraarterial chemotherapy (PRAC) and evaluate the long-term results of multimodality against colorectal cancer.

METHODSSeldinger procedure was used to intubate the tube to the artery branch which supplied blood to the tumor. The tumor was imaged to make sure the diagnosis and irrigate the chemotherapeutic drugs. Ten days after PRAC, the patients received radical operation and 6 chemotherapeutic courses with FCF regimen. Concurrent patients receiving surgical treatment yet no PRAC therapy were chosen as controls.

RESULTSOne-year survival rate was 93.05% in the PRAC group and 80.78% in the controls (P = 0.023). COX multivariate analysis was used to analyse the prognostic factors. Dukes'staging and the PRAC prescription or not were found to be independent prognostic factors of colorectal cancer patients. Patients in the PRAC group survived longer than those in the control group.

CONCLUSIONPRAC can improve the survival of colorectal cancer patients.

Antineoplastic Agents ; administration & dosage ; Colorectal Neoplasms ; drug therapy ; mortality ; pathology ; Female ; Humans ; Infusions, Intra-Arterial ; Male ; Middle Aged ; Prognosis