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

OBJECTIVEThis review discusses the current status and progress in studies on gastric cancer with liver metastasis (GCLM), involving the routes, subtypes, and prognosis of GCLM; the genes and molecules associated with metastasis; the feasibility and value of each imaging modality; and current treatment options.

DATA SOURCESThe data used in this review were mainly from Medline and PubMed published in English from 2005 to August 2010. The search terms were "gastric cancer" and "liver metastasis".

STUDY SELECTIONArticles regarding the characteristics, diagnostic modalities, and various therapeutic options of GCLM were selected.

RESULTSThe prognosis of GCLM is influenced by the clinicopathological characteristics of primary tumors, as well as the presence of liver metastases. Improved understanding of related genes and molecules will lead to the development of methods of early detection and targeted therapies. For the diagnosis of GCLM, each imaging modality has its relative benefits. There remains no consensus regarding therapeutic options.

CONCLUSIONSEarly detection and characterization of liver metastases is crucial for the prognosis of gastric cancer patients. Multidisciplinary team discussions are required to design optimal treatment strategies, which should be based on the clinicopathological characteristics of each patient.

Humans ; Liver Neoplasms ; diagnosis ; drug therapy ; secondary ; surgery ; Stomach Neoplasms ; complications ; diagnosis ; drug therapy ; surgery

As the most common metastasis in colorectal cancer, liver metastasis is the primary cause of treatment failure. Resection plays a dominant role in multidisciplinary treatment of colorectal liver metastases. However, this surgical field is still filled with disputes and challenges. Literature on liver metastasis of colorectal cancer were reviewed and clinical trials were collected. Different opinions were analyzed according to clinical evidence and personal experience. There are many disputes about surgical treatment of colorectal liver metastases, including incomplete staging system, inconsistent criteria of potential resectability, neoadjuvant chemotherapy for resectable liver metastases, adjuvant chemotherapy regimen after radical resection, and treatment of asymptomatic primary lesion in patients with unresectable liver metastasis.
Chemotherapy, Adjuvant ; Hepatectomy ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; surgery ; Neoadjuvant Therapy

INTRODUCTIONPatients with peritoneal metastases (PM) from hepatocellular carcinoma (HCC) often experience a rapid demise even after a complete removal of intrahepatic tumour. Localised PM may now be adequately controlled and managed with cytoreductive surgery (CRS).

TREATMENTThree patients underwent CRS for HCC PM.

OUTCOMEThe first patient survived 21 months from the time of CRS and is alive with the disease. The second patient died 4 months after CRS. The third patient survived 10 months since CRS and is also alive with the disease. Collectively, the survival of 24 patients with HCC PM extracted through a collective literature review who were treated with cytoreductive surgery had 1- and 2-year survival percentages of 83% and 71%, respectively.

CONCLUSIONCareful selection of patients with localised disease to the peritoneal cavity for CRS, taking into consideration the performance status, liver function and tumour biology may lead to a successful outcome in patients with HCC PM.

Carcinoma, Hepatocellular ; drug therapy ; pathology ; surgery ; Fatal Outcome ; Female ; Humans ; Liver Neoplasms ; drug therapy ; pathology ; surgery ; Male ; Middle Aged ; Peritoneal Neoplasms ; drug therapy ; secondary ; surgery ; Peritoneum ; pathology ; Young Adult

OBJECTIVETo evaluate the therapeutic efficacy of simultaneous laparoscopic excision for the treatment of rectal carcinoma and synchronous hepatic metastasis.

METHODSTotally 38 patients with rectal carcinoma and synchronous hepatic metastasis detected by CT scan were included in this study. Among them, 23 patients in the group A were treated with laparoscopic surgery, and the other 18 patients in the group B with traditional abdominal operation to resect the rectal tumor and hepatic metastasis simultaneously. All patients received postoperative chemotherapy.

RESULTSAll the patients were treated successfully with no postoperative death in both groups. The mean operative time was 350 +/- 45 min in group A versus 342 +/- 38 min in group B (P > 0.05). The mean blood loss was 275 +/- 96 ml in group A versus 590 +/- 85 ml in group B (P < 0.01), and the average hospital stay was 12 +/- 1.5 days in group A versus 16 +/- 2.5 days in group B (P < 0.05). Only one patient in group A received blood transfusion of 200 ml during operation, while the average blood transfusion in group B was 500 +/- 100 ml (P < 0.01). The follow-up duration was from 36 to 72 months with an average duration of 45.3 months. The 1-, 3- and 5-year survival rates were 82.6%, 43.5% and 8.6% in the group A, versus 77.8%, 38.9% and 0% in group B, respectively (P > 0.05).

CONCLUSIONSimultaneous laparoscopic excision of rectal carcinoma and synchronous hepatic metastasis is safe, effective and minimally invasive with a similar survival achieved by traditional open abdominal operation.

Adenocarcinoma ; drug therapy ; secondary ; surgery ; Aged ; Blood Loss, Surgical ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; methods ; Length of Stay ; Liver Neoplasms ; drug therapy ; secondary ; surgery ; Male ; Middle Aged ; Rectal Neoplasms ; drug therapy ; pathology ; surgery ; Survival Rate

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Colorectal Neoplasms ; pathology ; surgery ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; surgery ; Neoadjuvant Therapy ; Preoperative Care ; Survival Rate

OBJECTIVETo investigate the therapeutic effect and safety of Sorafenib in the treatment of tumor recurrence after orthotopic liver transplantation (OLT).

METHODSBetween January, 2009 and June, 2011, 10 patients with tumor recurrence after OLT were treated with Sorafenib (group A) and another 8 recipients received no Sorafenib treatment (group B); 25 patients with hepatocellular carcinoma (HCC) also received Sorafenib treatment (group C). The tumor-bearing survival time, adverse effect and toxicity associated with sorafenib were compared between the 3 groups.

RESULTSIn group A, the median tumor-bearing survival time was 10 months (5-22 months), as compared to 4 months (1-8 months) in group B and 4 months (2-21 months) in group C, showing a significant difference in the survival time among the 3 groups (Kaplan-Meier, log-rank test, P=0.045). No recipient experienced acute graft rejection, but one recipient in group A died due to gastrointestinal bleeding. No significant difference was found in adverse effects associated with Sorafenib between groups A and C (P<0.05).

CONCLUSIONSorafenib can prolong the survival time of patients with tumor recurrence after OLT without increasing the risk of acute graft rejection.

Carcinoma, Hepatocellular ; drug therapy ; surgery ; Female ; Humans ; Liver Neoplasms ; drug therapy ; surgery ; Liver Transplantation ; Male ; Neoplasm Recurrence, Local ; drug therapy ; Niacinamide ; analogs & derivatives ; therapeutic use ; Phenylurea Compounds ; therapeutic use ; Postoperative Period ; Survival Rate ; Treatment Outcome

OBJECTIVE: We wanted to determine whether combined radiofrequency ablation (RFA) and acetic acid-hypertonic saline solution (AHS) instillation can increase the extent of thermally mediated coagulation in in vivo rabbit liver tissue. We also wished to determine the optimal concentration of the solution in order to maximize its effect on extent of the RFA-induced coagulation. MAERIALS AND METHODS: Forty thermal ablation zones were produced in 40 rabbits by using a 17-gauge internally cooled electrode with a 1-cm active tip under ultrasound guidance. The rabbits were assigned to one of four groups: group A: RFA alone (n=10) ; group B: RFA with 50% AHS instillation (n=10) ; group C: RFA with 25% AHS instillation (n=10) ; group D: RFA with 15% AHS instillation (n=10). A range of acetic acid concentrations diluted in 36% NaCl to a total volume of 1 mL were instilled into the liver before RFA. The RF energy (30 W) was applied for three minutes. After RFA, in each group, the maximum diameters of the thermal ablation zones in the gross specimens were compared. Technical success and the complications that arose were evaluated by CT and on the basis of autopsy findings. RESULTS: All procedures are technically successful. There were six procedure-related complications (6/40; 15%) : two localized perihepatic hematomas and four chemical peritonitis. The incidence of chemical peritonitis was highest for group B with the 50% AHS solution instillation (30%). With instillation of 15% AHS solution, a marked decrease of tissue impedance (24.5+/-15.6 omega) and an increase of current (250 mA) occurred as compared to RFA alone. With instillation of the solutions before RFA (group B, C and D), this produced a greater mean diameter of coagulation necrosis than the diameters for rabbits not instilled with the solution (group A) (p < 0.05). However, there was no significant difference between group B, C, and D. CONCLUSION: Combined AHS instillation and RFA can increase the dimension of coagulation necrosis in the liver with a single application. A low concentration of AHS (15%) showed similar effects in increasing the extent of RF-induced coagulation, but there were less side effects as compared to the high concentration of AHS.
Acetic Acid/*administration & dosage ; Animals ; *Catheter Ablation ; Combined Modality Therapy ; Instillation, Drug ; Liver/*drug effects/pathology/*surgery ; Liver Neoplasms/drug therapy/surgery ; Necrosis ; Rabbits ; Saline Solution, Hypertonic/*administration & dosage

OBJECTIVETo investigate the indication of surgical treatment for primary colorectal carcer with simultaneous hepatic metastasis.

METHODS116 colorectal cancer patients with simultaneous hepatic metastasis underwent surgery from January 1990 to December 2001. The data were analyzed using Statistical Package for the Social Sciences (Release 11.5, SPSS, Inc). The survival was estimated using Kaplan-Meier method, and the survival comparison was carried out using the log-rank test. Multivariate analysis was performed using Cox regression.

RESULTSTotally, 116 patients received surgical resection for primary colorectal tumor, 18 of them underwent liver metastasis resection simultaneously. Postoperative complication developed in 14.7% of these patients with postoperative death in two patients. The overall 5-year survival rate was 14.29%. The 5-year survival rate of those who had liver metastasis resection was 32.12%. Multivariate analysis showed that liver metastasis resection, abdominal carcinomatosis, chemotherapy and intervention treatment were the most important prognostic factors.

CONCLUSIONSurgical resection of primary colorectal cancer with simultaneous resection of liver metastasis or with combined modality therapies such as chemotherapy and intervention treatment is effective to prolong patient's survival for primary colorectal cancer patient with simultaneous hepatic metastasis.

Adenocarcinoma ; drug therapy ; secondary ; surgery ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Chemotherapy, Adjuvant ; Colectomy ; methods ; Colonic Neoplasms ; drug therapy ; pathology ; surgery ; Female ; Follow-Up Studies ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Proportional Hazards Models ; Rectal Neoplasms ; drug therapy ; pathology ; surgery ; Rectum ; surgery ; Survival Rate ; Young Adult

A 68-year-old male was admitted due to fatigue and poor appetite and diagnosed pathologically as pancreatic adenocarcinoma with liver metastasis. The tumor marker carbohydrate antigen 199 (CA199) level was 2003.4 U/mL. The patient received two cycles of modified FOLFIRINOX plus immune checkpoint inhibitor (penpulimab). However, the tumor did not shrink and CA199 level was even higher. Anlotinib was added from the 3rd cycle, and the size of primary tumor and metastatic lesions were significantly reduced. Laparoscopic distal pancreatectomy and splenectomy as well as liver metastasis resection was performed. Three cycles of combined therapy were adopted after surgery followed by maintenance therapy with anlotinib plus penpulimab. There was no evidence of tumor recurrence during the follow-up (nearly 19 months since diagnosis).
Male ; Humans ; Aged ; Pancreatic Neoplasms/drug therapy* ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Adenocarcinoma ; Neoplasm Recurrence, Local/surgery* ; Immunotherapy ; Liver Neoplasms/therapy* ; Pancreatectomy