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

Since the hepatocellular carcinoma (HCC) develops in cirrhotic liver and is often multicentric, liver transplantation (LT) seems to be a rational approach for the treatment of HCC. Current selection criteria of LT for HCC are Milan criteria (single nodule < or = 5 cm , or < or = 3 nodules and Carcinoma, Hepatocellular/etiology/*mortality/*surgery ; Humans ; Liver Cirrhosis/*complications ; Liver Neoplasms/etiology/*mortality/*surgery ; *Liver Transplantation ; Salvage Therapy ; Survival Rate

To explore the feasibility and efficacy of isolated caudate lobe resection for caudate lobe in huge hepatocellular carcinoma(10 cm or larger in diameter).
 Methods: Clinical data of 27 patients with hepatocellular carcinoma larger than 10 cm who underwent isolated caudate lobe resection from January 2001 to December 2011 were retrospectively analyzed.
 Results: All the patients successfully completed the operation. There was no postoperative death. Median operative time was 288 min, and the estimated intraoperative blood loss was 2 260 mL. Postoperative morbidity rate was 44.4%. The patients were discharged successfully after active treatment. Overall survival rates at 1, 3, and 5 years were 80.2%, 52.1%, and 27.1%, respectively.
 Conclusion: Isolated caudate lobe resection is safe and effective for caudate lobe huge hepatocellular carcinoma.
Carcinoma, Hepatocellular ; mortality ; surgery ; Hepatectomy ; Humans ; Liver Neoplasms ; mortality ; surgery ; Retrospective Studies ; Survival Analysis ; Treatment Outcome

BACKGROUNDMany studies have reported the benefit of hepatic resection for solitary and metachronous metastases from gastric cancer. However, indications and surgical results for synchronous hepatic metastases from gastric carcinoma have not been clearly defined. This study was performed to assess the benefits and limits of simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases, as well as to identify prognostic factors affecting the survival.

METHODSBetween January 2005 and June 2008, 13 patients with synchronous hepatic metastases underwent simultaneous combined resection. The clinicopathologic features and the surgical results of the 13 patients were retrospectively analyzed. Patient, tumor (primary and metastatic carcinoma), and operative parameters were analyzed for their influence on survival.

RESULTSNo patient died and two patients (15.4%) developed complications during peri-operative course. The actuarial 6-month, 1-year, and 2-year survival rates after hepatic resection were 76.9%, 38.5%, and 30.8%, respectively, and two patients survived for more than 2 years after surgery without any signs of recurrences until latest follow-up. In univariate analysis, hepatic tumor distribution (P=0.01) and number of hepatic metastases (P=0.003) were significant prognostic factors that influenced survival. Factors associated with the primary lesion were not significant prognostic factors.

CONCLUSIONSSatisfactory survival may be achieved by simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases in strictly selected patients. The number of hepatic metastases and hepatic tumor distribution are significant prognostic determinants of survival.

Aged ; Female ; Hepatectomy ; mortality ; Humans ; Liver Neoplasms ; mortality ; secondary ; surgery ; Male ; Middle Aged ; Stomach Neoplasms ; complications

No abstract available.
Carcinoma, Hepatocellular/mortality/*surgery ; Hepatectomy ; Human ; Liver Neoplasms/mortality/*surgery ; Liver Transplantation ; Neoplasm Recurrence, Local ; Survival Rate

Along with the improvement of surgical techniques and post-transplant management, the role of liver transplantation in hepatocellular carcinoma (HCC) treatment has become increasingly important. Although HCC now is an indication of liver transplantation, the criteria of HCC candidates selection vary in different transplantation centers in China. On the contrary, the HCC candidates selection criteria in western countries are relatively strict, among which Milan criteria, University of California, San Francisco (UCSF) criteria, and Pittsburgh modified TNM criteria are widely acknowledged. However, Milan criteria and UCSF criteria only focus on tumor diameter and tumor number but ignore some important risk factors such as vascular invasion and histological differentiation. In our opinion, the biological behaviors of tumor are as important as tumor burden. A set of new candidates selection and prognostic criteria of liver transplantation in HCC patients named "Hangzhou criteria" has been established based on China's real situations and on the results of our long-term research. Hangzhou criteria expands and surpasses Milan criteria, including several important risk factors. According to Hangzhou criteria, more HCC patients are given opportunities to receive liver transplantation and achieved favorable long-term survival. Also in this article, we reviewed the peri-transplantation therapy of HCC to reduce the tumor recurrence and improve the long-term survival after transplantation for the purpose of making liver transplantation more effective and reliable for HCC treatment.
Carcinoma, Hepatocellular ; mortality ; pathology ; surgery ; China ; Humans ; Liver Neoplasms ; mortality ; pathology ; surgery ; Liver Transplantation ; Patient Selection ; Treatment Outcome

BACKGROUNDPittsburgh modified TNM criteria is one of the prognostic models of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). In this study, we applied this prognostic system in a series of HCC patients receiving OLT to verify its reliability in the clinical prognostic prediction.

METHODSThe clinical record and follow-up data of 102 patients with HCC underwent OLT was collected. The patients were classified by 3 staging systems: the Pittsburgh Modified TNM Criteria, International Union Against Cancer (UICC) pTNM Staging System, and Milan Criteria. Survival rates of the patients were analyzed using the Kaplan-Meier method and the Log-Rank test, and then the prognostic values of the 3 staging systems were compared.

RESULTSAmong the 3 staging systems, the Pittsburgh Modified TNM Criteria showed the best stratification of patients with different prognosis. The overall survival rates of the patients at the Pittsburgh modified TNM stage I, II, III, and IV were 94.4%, 83.3%, 58.2%, and 36.8% at 1 year, and 79.4%, 62.5%, 26.2%, and 10.5% at 3 years, respectively. For those patients exceeding the Milan Criteria, the patients at Pittsburgh stages I and II had a significant higher survival rate than those at Pittsburgh stages III and IV (P < 0.001).

CONCLUSIONSThe Pittsburgh Modified TNM Criteria is a more reliable postoperative staging system than the UICC pTNM staging system for HCC patients receiving OLT. As providing more accurate prognostic classification, it could be reasonable to combine the Milan Criteria for recipient selection.

Carcinoma, Hepatocellular ; mortality ; pathology ; surgery ; Female ; Humans ; Liver Neoplasms ; mortality ; pathology ; surgery ; Liver Transplantation ; Male ; Neoplasm Staging ; Prognosis ; Survival Rate

OBJECTIVETo investigate the value of liver transplantation for late hepatocellular carcinoma.

METHODSThirty-six patients were treated by liver transplantation from August 2000 to February 2002, of which 15 patients had had advanced hepatocellular carcinoma and thirteen of these 15 patients were evaluated for results.

RESULTSThe 1-year survival rate was 86% (6/7). Only one patient died of recurrence within 6 months. The tumor-free survival was 5 to 19 months. Till February 2002, two patients have survived for 10 months and 19 months with recurrence.

CONCLUSIONIn our country, if the patients can afford liver transplantation, advanced hepatocellular carcinoma without extrahepatic metastasis is still indicated for liver transplantation, since some patients may survive relatively long.

Adult ; Carcinoma, Hepatocellular ; mortality ; surgery ; Female ; Humans ; Liver Neoplasms ; mortality ; surgery ; Liver Transplantation ; Male ; Middle Aged ; Neoplasm Recurrence, Local

BACKGROUNDRectal carcinoma patients are often accompanied by hepatic metastasis. The aim of this study was to evaluate the therapeutic efficacy of simultaneous laparoscopic excision for rectal carcinoma with synchronous hepatic metastasis.

METHODSA total of 41 patients with rectal carcinoma and synchronous hepatic metastasis detected by CT scan were included in this study. Among them, 23 patients underwent laparoscopic surgery and 18 patients underwent traditional open surgery to simultaneously remove the rectal tumor and hepatic metastasis lesions. All patients received postoperative adjuvant chemotherapy. All the patients were followed up from 36 to 72 months (mean 45.3 months).

RESULTSAll the operations were performed successfully and no patient was turned to open surgery in laparoscopic group. The mean blood loss, the mean postoperative hospital stay, the mean blood transfusion and the mean intestinal functional recovery time showed a significant difference between the two groups (P < 0.05). The 1-, 3- and 5-year survival rates were 82.6%, 43.5% and 8.6% in the laparoscopic group, without significant difference compared with the open group (77.8%, 38.9% and 0) (P > 0.05).

CONCLUSIONSSimultaneous laparoscopic excision for rectal carcinoma and synchronous hepatic metastasis is safe and effective with similar survival achieved by the traditional open abdominal surgery.

Adult ; Aged ; Carcinoma ; mortality ; surgery ; Female ; Humans ; Laparoscopy ; Liver Neoplasms ; mortality ; secondary ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Rectal Neoplasms ; mortality ; surgery

Hepatocellular carcinoma (HCC) is one of the most prevalent malignant tumors worldwide. Liver transplantation (LT) is known as a curative and therapeutic modality. However, the survival rates of recipients after LT are still not good enough because of tumor recurrence. To improve the survival rates of recipients after LT, identifying predictive factors for prognosis after LT and establishing a model assessing prognosis are very important to HCC patients. There has recently been a lot of clinical and basic research on recurrence and prognosis after LT. Progress has been made, especially in selection criteria for LT recipients and risk factors for predicting prognosis after LT. Hangzhou criteria, in line with China's high current incidence rate of primary liver, are first proposed by Chinese scholars of LT, and are accepted world-wide, and make an important contribution to the development of LT.
Carcinoma, Hepatocellular ; mortality ; surgery ; China ; epidemiology ; Humans ; Liver Neoplasms ; mortality ; surgery ; Liver Transplantation ; Neoplasm Recurrence, Local ; mortality ; Patient Selection ; Prognosis ; Risk Factors ; Survival Rate