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1. The use of an evidence based approach to guide optimal surgical management of colorectal liver metastases

Author

Simillis, C., Davidson, B. R., and Gurusamy, K. S.

Abstract

The aim of this thesis was to validate the optimal surgical management of colorectal liver metastases (CLM) by using an evidence based approach. A meta-analysis comparing combined and sequential resection for synchronous CLM demonstrated that combined resection is associated with reduced hospital stay and with comparable perioperative mortality and morbidity, operative blood loss, and survival rates as sequential resection. Nevertheless, combined resection was associated with lower metastatic disease severity compared to sequential resection. A meta-analysis assessed liver resection for CLM in the presence of hepatic lymph node involvement and demonstrated that survival rates are lower in node positive disease patients compared to node negative disease patients, irrespective of whether the positive disease nodes were detected by routine or selective lymphadenectomy, or whether nodal involvement was microscopic or macroscopic. A network meta-analysis comparing different treatment strategies aiming to decrease operative blood loss found no difference in mortality, length of hospital stay or ITU stay between the treatment strategies. The use of radiofrequency dissecting sealer resulted in more serious adverse events compared to the clamp-crush method in the absence of vascular occlusion and fibrin sealant. Simple methods, such as clamp-crush method, gave overall equivalent outcomes to methods which require special equipment. Not reporting the period of follow-up was investigated as a potential source of study bias. Overall analysis did not identify a significant difference in mortality and disease recurrence, but sensitivity analysis of more recent reviews and larger reviews showed that the trials reporting the period of follow-up had a significantly lower hazard ratio for disease recurrence compared to trials not reporting the period of follow-up. A network meta-analysis comparing interventions aiming to decrease ischaemia-reperfusion injury during liver resection, demonstrated that ischaemic preconditioning resulted in fewer serious adverse events, lower operative blood loss, fewer transfusion proportions, and shorter operative time.

Published
2016

2. Multisocietal European consensus on the terminology, diagnosis, and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE

Author

Siriwardena, A, Serrablo, A, Fretland, A, Wigmore, S, Ramia-Angel, J, Malik, H, Stattner, S, Soreide, K, Zmora, O, Meijerink, M, Kartalis, N, Lesurtel, M, Verhoef, K, Balakrishnan, A, Gruenberger, T, Jonas, E, Devar, J, Jamdar, S, Jones, R, Hilal, M, Andersson, B, Boudjema, K, Mullamitha, S, Stassen, L, Dasari, B, Frampton, A, Aldrighetti, L, Pellino, G, Buchwald, P, Gurses, B, Wasserberg, N, Gruenberger, B, Spiers, H, Jarnagin, W, Vauthey, J, Kokudo, N, Tejpar, S, Valdivieso, A, Adam, R, Lang, H, Smith, M, Deoliveira, M, Adair, A, Gilg, S, Swijnenburg, R, Jaekers, J, Jegatheeswaran, S, Buis, C, Parks, R, Bockhorn, M, Conroy, T, Petras, P, Primavesi, F, Chan, A, Cipriani, F, Rubbia-Brandt, L, Foster, L, Abdelaal, A, Yaqub, S, Rahbari, N, Fondevila, C, Abradelo, M, Kok, N, Tejedor, L, Martinez-Baena, D, Azoulay, D, Maglione, M, Serradilla-Martin, M, Azevedo, J, Romano, F, Line, P, Forcen, T, Panis, Y, Stylianides, N, Bale, R, Quaia, E, Yassin, N, Duque, V, Espin-Basany, E, Mellenhorst, J, Rees, A, Adeyeye, A, Tuynman, J, Simillis, C, Duff, S, Wilson, R, De Nardi, P, Palmer, G, Zakaria, A, Perra, T, Porcu, A, Tamini, N, Kelly, M, Metwally, I, Morarasu, S, Carbone, F, Estaire-Gomez, M, Perez, E, Seligmann, J, Gollins, S, Braun, M, Hessheimer, A, Alonso, V, Radhakrishna, G, Alam, N, Camposorias, C, Barriuoso, J, Ross, P, Ba-Ssalamah, A, Muthu, S, Filobbos, R, Nadarajah, V, Hattab, A, Newton, C, Barker, S, Sibbald, J, Hancock, J, de Liguori Carino, N, Deshpande, R, Lancellotti, F, Paterna, S, Gutierrez-Diez, M, Artigas, C, Siriwardena A. K., Serrablo A., Fretland A. A., Wigmore S. J., Ramia-Angel J. M., Malik H. Z., Stattner S., Soreide K., Zmora O., Meijerink M., Kartalis N., Lesurtel M., Verhoef K., Balakrishnan A., Gruenberger T., Jonas E., Devar J., Jamdar S., Jones R., Hilal M. A., Andersson B., Boudjema K., Mullamitha S., Stassen L., Dasari B. V. M., Frampton A. E., Aldrighetti L., Pellino G., Buchwald P., Gurses B., Wasserberg N., Gruenberger B., Spiers H. V. M., Jarnagin W., Vauthey J. -N., Kokudo N., Tejpar S., Valdivieso A., Adam R., Lang H., Smith M., deOliveira M. L., Adair A., Gilg S., Swijnenburg R. -J., Jaekers J., Jegatheeswaran S., Buis C., Parks R., Bockhorn M., Conroy T., Petras P., Primavesi F., Chan A. K. C., Cipriani F., Rubbia-Brandt L., Foster L., Abdelaal A., Yaqub S., Rahbari N., Fondevila C., Abradelo M., Kok N. F. M., Tejedor L., Martinez-Baena D., Azoulay D., Maglione M., Serradilla-Martin M., Azevedo J., Romano F., Line P. -D., Forcen T. A., Panis Y., Stylianides N., Bale R., Quaia E., Yassin N., Duque V., Espin-Basany E., Mellenhorst J., Rees A., Adeyeye A., Tuynman J. B., Simillis C., Duff S., Wilson R., De Nardi P., Palmer G. J., Zakaria A. D., Perra T., Porcu A., Tamini N., Kelly M. E., Metwally I., Morarasu S., Carbone F., Estaire-Gomez M., Perez E. M., Seligmann J., Gollins S., Braun M., Hessheimer A., Alonso V., Radhakrishna G., Alam N., Camposorias C., Barriuoso J., Ross P., Ba-Ssalamah A., Muthu S., Filobbos R., Nadarajah V., Hattab A., Newton C., Barker S., Sibbald J., Hancock J., de Liguori Carino N., Deshpande R., Lancellotti F., Paterna S., Gutierrez-Diez M., Artigas C., Siriwardena, A, Serrablo, A, Fretland, A, Wigmore, S, Ramia-Angel, J, Malik, H, Stattner, S, Soreide, K, Zmora, O, Meijerink, M, Kartalis, N, Lesurtel, M, Verhoef, K, Balakrishnan, A, Gruenberger, T, Jonas, E, Devar, J, Jamdar, S, Jones, R, Hilal, M, Andersson, B, Boudjema, K, Mullamitha, S, Stassen, L, Dasari, B, Frampton, A, Aldrighetti, L, Pellino, G, Buchwald, P, Gurses, B, Wasserberg, N, Gruenberger, B, Spiers, H, Jarnagin, W, Vauthey, J, Kokudo, N, Tejpar, S, Valdivieso, A, Adam, R, Lang, H, Smith, M, Deoliveira, M, Adair, A, Gilg, S, Swijnenburg, R, Jaekers, J, Jegatheeswaran, S, Buis, C, Parks, R, Bockhorn, M, Conroy, T, Petras, P, Primavesi, F, Chan, A, Cipriani, F, Rubbia-Brandt, L, Foster, L, Abdelaal, A, Yaqub, S, Rahbari, N, Fondevila, C, Abradelo, M, Kok, N, Tejedor, L, Martinez-Baena, D, Azoulay, D, Maglione, M, Serradilla-Martin, M, Azevedo, J, Romano, F, Line, P, Forcen, T, Panis, Y, Stylianides, N, Bale, R, Quaia, E, Yassin, N, Duque, V, Espin-Basany, E, Mellenhorst, J, Rees, A, Adeyeye, A, Tuynman, J, Simillis, C, Duff, S, Wilson, R, De Nardi, P, Palmer, G, Zakaria, A, Perra, T, Porcu, A, Tamini, N, Kelly, M, Metwally, I, Morarasu, S, Carbone, F, Estaire-Gomez, M, Perez, E, Seligmann, J, Gollins, S, Braun, M, Hessheimer, A, Alonso, V, Radhakrishna, G, Alam, N, Camposorias, C, Barriuoso, J, Ross, P, Ba-Ssalamah, A, Muthu, S, Filobbos, R, Nadarajah, V, Hattab, A, Newton, C, Barker, S, Sibbald, J, Hancock, J, de Liguori Carino, N, Deshpande, R, Lancellotti, F, Paterna, S, Gutierrez-Diez, M, Artigas, C, Siriwardena A. K., Serrablo A., Fretland A. A., Wigmore S. J., Ramia-Angel J. M., Malik H. Z., Stattner S., Soreide K., Zmora O., Meijerink M., Kartalis N., Lesurtel M., Verhoef K., Balakrishnan A., Gruenberger T., Jonas E., Devar J., Jamdar S., Jones R., Hilal M. A., Andersson B., Boudjema K., Mullamitha S., Stassen L., Dasari B. V. M., Frampton A. E., Aldrighetti L., Pellino G., Buchwald P., Gurses B., Wasserberg N., Gruenberger B., Spiers H. V. M., Jarnagin W., Vauthey J. -N., Kokudo N., Tejpar S., Valdivieso A., Adam R., Lang H., Smith M., deOliveira M. L., Adair A., Gilg S., Swijnenburg R. -J., Jaekers J., Jegatheeswaran S., Buis C., Parks R., Bockhorn M., Conroy T., Petras P., Primavesi F., Chan A. K. C., Cipriani F., Rubbia-Brandt L., Foster L., Abdelaal A., Yaqub S., Rahbari N., Fondevila C., Abradelo M., Kok N. F. M., Tejedor L., Martinez-Baena D., Azoulay D., Maglione M., Serradilla-Martin M., Azevedo J., Romano F., Line P. -D., Forcen T. A., Panis Y., Stylianides N., Bale R., Quaia E., Yassin N., Duque V., Espin-Basany E., Mellenhorst J., Rees A., Adeyeye A., Tuynman J. B., Simillis C., Duff S., Wilson R., De Nardi P., Palmer G. J., Zakaria A. D., Perra T., Porcu A., Tamini N., Kelly M. E., Metwally I., Morarasu S., Carbone F., Estaire-Gomez M., Perez E. M., Seligmann J., Gollins S., Braun M., Hessheimer A., Alonso V., Radhakrishna G., Alam N., Camposorias C., Barriuoso J., Ross P., Ba-Ssalamah A., Muthu S., Filobbos R., Nadarajah V., Hattab A., Newton C., Barker S., Sibbald J., Hancock J., de Liguori Carino N., Deshpande R., Lancellotti F., Paterna S., Gutierrez-Diez M., and Artigas C.

Abstract

Background: Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases, with a focus on terminology, diagnosis, and management. Methods: This project was a multiorganizational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis, and management. Statements were refined during an online Delphi process, and those with 70 per cent agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising 12 key statements. Results: Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term 'early metachronous metastases' applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour, the term 'late metachronous metastases' applies to those detected after 12 months. 'Disappearing metastases' applies to lesions that are no longer detectable on MRI after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards, and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways, including systemic chemotherapy, synchronous surgery, and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed. Conclusion: The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.

Published
2023

3. The multi-societal European consensus on the terminology, diagnosis and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE

Author

Siriwardena, A, Serrablo, A, Fretland, A, Wigmore, S, Ramia-Angel, J, Malik, H, Stattner, S, Soreide, K, Zmora, O, Meijerink, M, Kartalis, N, Lesurtel, M, Verhoef, C, Balakrishnan, A, Gruenberger, T, Jonas, E, Devar, J, Jamdar, S, Jones, R, Hilal, M, Andersson, B, Boudjema, K, Mullamitha, S, Stassen, L, Dasari, B, Frampton, A, Aldrighetti, L, Pellino, G, Buchwald, P, Gurses, B, Wasserberg, N, Gruenberger, B, Spiers, H, Jarnagin, W, Vauthey, J, Kokudo, N, Tejpar, S, Valdivieso, A, Adam, R, Hauke, L, Smith, M, Deoliveira, M, Adair, A, Gilg, S, Swijnenburg, R, Jaekers, J, Jegatheeswaran, S, Buis, C, Parks, R, Bockhorn, M, Conroy, T, Petras, P, Primavesi, F, Chan, A, Cipriani, F, Rubbia-Brandt, L, Foster, L, Abdelaal, A, Yaqub, S, Rahbari, N, Fondevila, C, Abradelo, M, Kok, N, Tejedor, L, Martinez-Baena, D, Azoulay, D, Maglione, M, Serradilla-Martin, M, Azevedo, J, Romano, F, Line, P, Forcen, T, Panis, Y, Stylianides, N, Bale, R, Quaia, E, Yassin, N, Duque, V, Espin-Basany, E, Mellenhorst, J, Rees, A, Adeyeye, A, Tuynman, J, Simillis, C, Duff, S, Wilson, R, De Nardi, P, Palmer, G, Zakaria, A, Perra, T, Porcu, A, Tamini, N, Kelly, M, Metwally, I, Morarasu, S, Carbone, F, Estaire-Gomez, M, Perez, E, Seligmann, J, Gollins, S, Braun, M, Hessheimer, A, Alonso, V, Radhakrishna, G, Alam, N, Camposorias, C, Barriuoso, J, Ross, P, Ba-Ssalamah, A, Muthu, S, Filobbos, R, Nadarajah, V, Hattab, A, Newton, C, Barker, S, Sibbald, J, Hancock, J, de Liguori Carino, N, Deshpande, R, Lancellotti, F, Paterna, S, Gutierrez-Diez, M, Artigas, C, Siriwardena A. K., Serrablo A., Fretland A. A., Wigmore S. J., Ramia-Angel J. M., Malik H. Z., Stattner S., Soreide K., Zmora O., Meijerink M., Kartalis N., Lesurtel M., Verhoef C., Balakrishnan A., Gruenberger T., Jonas E., Devar J., Jamdar S., Jones R., Hilal M. A., Andersson B., Boudjema K., Mullamitha S., Stassen L., Dasari B. V. M., Frampton A. E., Aldrighetti L., Pellino G., Buchwald P., Gurses B., Wasserberg N., Gruenberger B., Spiers H. V. M., Jarnagin W., Vauthey J. -N., Kokudo N., Tejpar S., Valdivieso A., Adam R., Hauke Lang, Smith M., deOliveira M. L., Adair A., Gilg S., Swijnenburg R. -J., Jaekers J., Jegatheeswaran S., Buis C., Parks R., Bockhorn M., Conroy T., Petras P., Primavesi F., Chan A. K. C., Cipriani F., Rubbia-Brandt L., Foster L., Abdelaal A., Yaqub S., Rahbari N., Fondevila C., Abradelo M., Kok N. F., Tejedor L., Martinez-Baena D., Azoulay D., Maglione M., Serradilla-Martin M., Azevedo J., Romano F., Line P. -D., Forcen T. A., Panis Y., Stylianides N., Bale R., Quaia E., Yassin N., Duque V., Espin-Basany E., Mellenhorst J., Rees A., Adeyeye A., Tuynman J. B., Simillis C., Duff S., Wilson R., De Nardi P., Palmer G. J., Zakaria A. D., Perra T., Porcu A., Tamini N., Kelly M. E., Metwally I., Morarasu S., Carbone F., Estaire-Gomez M., Perez E. M., Seligmann J., Gollins S., Braun M., Hessheimer A., Alonso V., Radhakrishna G., Alam N., Camposorias C., Barriuoso J., Ross P., Ba-Ssalamah A., Muthu S., Filobbos R., Nadarajah V., Hattab A., Newton C., Barker S., Sibbald J., Hancock J., de Liguori Carino N., Deshpande R., Lancellotti F., Paterna S., Gutierrez-Diez M., Artigas C., Siriwardena, A, Serrablo, A, Fretland, A, Wigmore, S, Ramia-Angel, J, Malik, H, Stattner, S, Soreide, K, Zmora, O, Meijerink, M, Kartalis, N, Lesurtel, M, Verhoef, C, Balakrishnan, A, Gruenberger, T, Jonas, E, Devar, J, Jamdar, S, Jones, R, Hilal, M, Andersson, B, Boudjema, K, Mullamitha, S, Stassen, L, Dasari, B, Frampton, A, Aldrighetti, L, Pellino, G, Buchwald, P, Gurses, B, Wasserberg, N, Gruenberger, B, Spiers, H, Jarnagin, W, Vauthey, J, Kokudo, N, Tejpar, S, Valdivieso, A, Adam, R, Hauke, L, Smith, M, Deoliveira, M, Adair, A, Gilg, S, Swijnenburg, R, Jaekers, J, Jegatheeswaran, S, Buis, C, Parks, R, Bockhorn, M, Conroy, T, Petras, P, Primavesi, F, Chan, A, Cipriani, F, Rubbia-Brandt, L, Foster, L, Abdelaal, A, Yaqub, S, Rahbari, N, Fondevila, C, Abradelo, M, Kok, N, Tejedor, L, Martinez-Baena, D, Azoulay, D, Maglione, M, Serradilla-Martin, M, Azevedo, J, Romano, F, Line, P, Forcen, T, Panis, Y, Stylianides, N, Bale, R, Quaia, E, Yassin, N, Duque, V, Espin-Basany, E, Mellenhorst, J, Rees, A, Adeyeye, A, Tuynman, J, Simillis, C, Duff, S, Wilson, R, De Nardi, P, Palmer, G, Zakaria, A, Perra, T, Porcu, A, Tamini, N, Kelly, M, Metwally, I, Morarasu, S, Carbone, F, Estaire-Gomez, M, Perez, E, Seligmann, J, Gollins, S, Braun, M, Hessheimer, A, Alonso, V, Radhakrishna, G, Alam, N, Camposorias, C, Barriuoso, J, Ross, P, Ba-Ssalamah, A, Muthu, S, Filobbos, R, Nadarajah, V, Hattab, A, Newton, C, Barker, S, Sibbald, J, Hancock, J, de Liguori Carino, N, Deshpande, R, Lancellotti, F, Paterna, S, Gutierrez-Diez, M, Artigas, C, Siriwardena A. K., Serrablo A., Fretland A. A., Wigmore S. J., Ramia-Angel J. M., Malik H. Z., Stattner S., Soreide K., Zmora O., Meijerink M., Kartalis N., Lesurtel M., Verhoef C., Balakrishnan A., Gruenberger T., Jonas E., Devar J., Jamdar S., Jones R., Hilal M. A., Andersson B., Boudjema K., Mullamitha S., Stassen L., Dasari B. V. M., Frampton A. E., Aldrighetti L., Pellino G., Buchwald P., Gurses B., Wasserberg N., Gruenberger B., Spiers H. V. M., Jarnagin W., Vauthey J. -N., Kokudo N., Tejpar S., Valdivieso A., Adam R., Hauke Lang, Smith M., deOliveira M. L., Adair A., Gilg S., Swijnenburg R. -J., Jaekers J., Jegatheeswaran S., Buis C., Parks R., Bockhorn M., Conroy T., Petras P., Primavesi F., Chan A. K. C., Cipriani F., Rubbia-Brandt L., Foster L., Abdelaal A., Yaqub S., Rahbari N., Fondevila C., Abradelo M., Kok N. F., Tejedor L., Martinez-Baena D., Azoulay D., Maglione M., Serradilla-Martin M., Azevedo J., Romano F., Line P. -D., Forcen T. A., Panis Y., Stylianides N., Bale R., Quaia E., Yassin N., Duque V., Espin-Basany E., Mellenhorst J., Rees A., Adeyeye A., Tuynman J. B., Simillis C., Duff S., Wilson R., De Nardi P., Palmer G. J., Zakaria A. D., Perra T., Porcu A., Tamini N., Kelly M. E., Metwally I., Morarasu S., Carbone F., Estaire-Gomez M., Perez E. M., Seligmann J., Gollins S., Braun M., Hessheimer A., Alonso V., Radhakrishna G., Alam N., Camposorias C., Barriuoso J., Ross P., Ba-Ssalamah A., Muthu S., Filobbos R., Nadarajah V., Hattab A., Newton C., Barker S., Sibbald J., Hancock J., de Liguori Carino N., Deshpande R., Lancellotti F., Paterna S., Gutierrez-Diez M., and Artigas C.

Abstract

Background: Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases with a focus on terminology, diagnosis and management. Methods: This project was a multi-organisational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis and management. Statements were refined during an online Delphi process and those with 70% agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising twelve key statements. Results: Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term “early metachronous metastases” applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour with “late metachronous metastases” applied to those detected after 12 months. Disappearing metastases applies to lesions which are no longer detectable on MR scan after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways including systemic chemotherapy, synchronous surgery and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed. Conclusions: The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.

Published
2023

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