Management colorectal CA and liver mets - HBazan

Management colorectal CA and liver mets - HBazan -...

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Surgical Management  of Liver Metastases  from Colorectal  Carcinoma Hernan Bazan, MD 6 July 2004 Team IV Conference
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Background Incidence Results Controversies R 0  resection Anatomical vs. Non-anatomical Prognostic indicators Contraindications Portal Vein Embolization Increase resectability rate? Hepatic Artery Infusion Decrease the recurrence rate after liver resection? Natural History of Colorectal Liver Metastases
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Background Incidence Results Controversies R 0  resection Anatomical vs. Non-anatomical Prognostic indicators Contraindications Portal Vein Embolization Increase resectability rate? Hepatic Artery Infusion Decrease the recurrence rate after liver resection? Natural History of Colorectal Liver Metastases
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Colon Cancer In USA: 150,000 new cases/year 3 rd  most common cancer Liver  is the most commonly involved organ in patients with metastatic  disease ~20% patients with colon cancer present with liver metastases  An additional 20% will develop metachronous liver metastases (usually  within 3 years) Stage II: 20% Stage III: 50% Overall, ~30,000 patients will present annually in the USA with liver  metastases from colorectal cancer Only 10-20% patients with liver mets fulfill criteria for resection Overwhelming evidence that resection of liver metastases from  colorectal cancer is beneficial May result in disease-free survival for 20 years and more Colorectal Cancer Liver Metastases
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Results: Liver resection with curative intent for hepatic  metastases from colorectal cancer Since 1980, single-institution  series (>100 cases) reported 5- year survival figures from 18%- 46% German group (n=597) 5-year survival: 33% MSKCC (n=1,001 consecutive  cases) 5-year survival: 36% Natural history  of metastatic colon  cancer to liver: In the absence of treatment,  median survival is 9 months 5-year survival: Rare 1,745 consecutive patients with colorectal liver metastases, 1961-1993; Germany  Scheele and Altendorf-Hofmann.   Langenbeck’s Arch Surg  1999
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Each year, ~14,000 patients with colorectal cancer undergo liver resection to  remove metastatic disease After 2 years: 65% alive 25% have no detectable disease Recurrences are still observed in patients with liver resection Hence, the need for adjuvant treatments IV chemotherapy HAI Penna and Nordlinger.   British Medical Bulletin  2002
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Patient Selection Good cardiopulmonary function Liver function – Sufficient functional hepatic reserve If normal liver, up to 75% liver may be resected (6 of 8 segments) Caveat: Pre-op chemotherapy
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This note was uploaded on 12/21/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Management colorectal CA and liver mets - HBazan -...

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