Management Of Liver M E T A S T A S I S Patient Selection

Management of Liver Metastasis: Patient Selection S K Mathur MS,FACS Sr Consultant Surgeon Surgical Gastroenterology HPB Surgery & Liver Transplantation ,[object Object]

Management of Liver Metastasis: Patient Selection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management of Liver Metastasis: Patient Selection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management of Liver Metastasis: Patient Selection ,[object Object],[object Object],[object Object],[object Object],[object Object]

Management of Liver Metastasis: Patient Selection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ann Surg Oncol 2004

Management of Liver Metastasis: Patient Selection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Fong Y, Fortner J, Sun RL, et al. Ann Surg. 1999. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Fong Y, Fortner J, Sun RL, et al. Ann Surg. 1999.

Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Arru M ,et al Italy, World J Surg. 2008

A Nomogram for Predicting Disease-specific Survival After Hepatic Resection for Metastatic Colorectal Cancer Kattan MW, Gönen M, William R. Jarnagin WR, DeMatteo R, Michael D'Angelica M, Martin Weiser M, Leslie H. Blumgart LS, Fong Y, ,[object Object],Based on the Cox proportional hazards regression model, a nomogram was constructed (Fig. 2). A version of this nomogram that can be downloaded and installed on a pocket digital assistant (PDA) for routine use can be found at the follow Internet site: www.nomograms.org . It has a bootstrap-corrected concordance index of 0.612 and seems well calibrated Ann Surg. 2008;247(2):282-287

A Nomogram for Predicting Disease-specific Survival After Hepatic Resection for Metastatic Colorectal Cancer ,[object Object],[object Object],[object Object],[object Object],Ann Surg. 2008;247(2):282-287

Criteria for Resectability of Colorectal Liver Metastases ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Pawlik, T. M. et al. Oncologist 2008;13:51-64

Management of Liver Metastasis: Patient Selection Pawlik, T. M. et al. Oncologist 2008;13:51-64

Pawlik, T. M. et al. Oncologist 2008;13:51-64 Survival following hepatic resection of colorectal metastases is not associated with the width of the negative surgical margin as long as the margin is completely microscopically negative

Results of R0 Resection for Colorectal Liver Metastases Associated With Extrahepatic Disease Elias D et al ( France) Ann Surg Oncol 2004 ,[object Object],Multivariate Analysis of Prognostic Factors statistically significant negative factors in the Cox model : -presence of multiple sites of extrahepatic disease (including peritoneal carcinomatosis; P = .04) -more than five LMs ( P = .02). Conclusions: EHD in CRC patients with liver metastases should no longer be considered as a contraindication to hepatectomy.

Management of Liver Metastasis: Patient Selection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Choti MA. Current Colorectal Cancer reports 2008

New paradigm:4 main Criteria for Resectability of Colorectal Liver Metastases ,[object Object],[object Object],[object Object],[object Object],Pawlik, T. M. et al. Oncologist 2008;13:51-64

New paradigm:4 main Criteria for Resectability of Colorectal Liver Metastases ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[Ferrero A,et al World J Surg 2007; ]

Strategies to increase the Resectability ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Stratigies to increase the Resectability Two- stage heptectomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ann Surg 2000 & Ann Surg 2004

Strategies to increase the Resectability ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ann Surg 2004

Management of Liver Metastasis: Patient Selection ,[object Object],[object Object],[object Object]

Management of Liver Metastasis: Patient Selection for re-resection ,[object Object],[object Object],[object Object],[object Object],Cancer Control. 2006

Management of Liver Metastasis: Patient Selection in CRC Liver Metastases ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Choti MA. Current Colorectal Cancer reports 2008

Management of Liver Metastasis: Patient Selection for Local Ablation in Colorectal Liver Metastases ,[object Object],[object Object],[object Object],[object Object]

Predictors of Survival After Radiofrequency Thermal Ablation of Colorectal Cancer Metastases to the Liver: A Prospective Study ,[object Object],[object Object],Journal of Clinical Oncology, 2005

Management of Liver Metastasis: Patient Selection for LM from NET ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Mayo Clinic. J Am Coll Surg. 2003 Wisconsin Arch Surg. 2006

Treatment of liver metastases from neuroendocrine tumours in relation to the extent of hepatic disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Frilling, A.et al; B. J. S., Feb 2009

Treatment of liver metastases from neuroendocrine tumours in relation to the extent of hepatic disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Frilling, A.et al; B. J. S., Feb 2009

Management of Liver Metastasis: Patient Selection for LM from NET ,[object Object],[object Object],[object Object],[object Object],[object Object],M.D. Anderson Cancer Center Journal of Clinical Oncology , 2008: No Extra hepatic disease World J Surg Oncol. 2006 ;

Management of Liver Metastasis: Patient Selection Non Colorectal / Non NET Liver Metastasis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Adam et al Ann Surg 2006, Harrison et al . Surgery 1997

Hepatic Resection for Noncolorectal Nonendocrine Liver Mets Analysis of 1452 Patients and Development of a Prognostic Model :Paul Brousse Hospital Villejuif, France ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Adam et al Ann Surg 2006,

Hepatic Resection for Noncolorectal Nonendocrine Liver Mets Analysis of 1452 Patients and Development of a Prognostic Model :Paul Brousse Hospital Villejuif, France ,[object Object],[object Object],[object Object],[object Object],Adam et al Ann Surg 2006,

Management of Liver Metastasis: Patient Selection Non Colorectal / Non NET Liver Metastasis ,[object Object],[object Object],[object Object],[object Object],[object Object],Weitz et al. Ann Surg 2005

Management of Liver Metastasis: Patient Selection Non Colorectal / Non NET Liver Metastasis ,[object Object],[object Object],Adam et al Ann Surg 2006,

Management of Liver Metastasis: Patient Selection Non Colorectal / Non NET Liver Metastasis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Antonescu et al,Clin Can Res2005, Demato et al, Ann of Surg Oncology 2002 Adam et al Ann Surg 2006

Management of Liver Metastasis: Patient Selection Non Colorectal / Non NET Liver Metastasis ,[object Object],[object Object],[object Object],[object Object],[object Object],Rose et al. Sydney Melanoma unit 2001

Management of Liver Metastasis: Patient Selection Non Colorectal / Non NET Liver Metastasis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Elias et al, Am J Surg 2003

Management of Liver Metastasis: Patient Selection Non Colorectal / Non NET Liver Metastasis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Elias et al, Am J Surg 2003

Management of Liver Metastasis: Patient Selection Non Colorectal / Non NET Liver Metastasis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Gholam et al, Cancer 2003

Management of Liver Metastasis: Patient Selection Non Colorectal / Non NET Liver Metastasis ,[object Object],[object Object],[object Object],[object Object],[object Object]

Copyright ©2008 AlphaMed Press Pawlik, T. M. et al. Oncologist 2008;13:51-64 Over the last decade, the criteria for resectability of colorectal liver metastases have been expanded and have undergone a paradigm shift Management of Liver Metastasis: Patient Selection

Expanding Criteria for Resectability of Colorectal Liver Metastases Timothy M. Pawlik, Richard D. Schulick, Michael A. Choti John Hopkins ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],The Oncologist, 2008;

Management of Liver Metastasis: Patient Selection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management of Liver Metastasis: Patient Selection: Conclusions ,[object Object],[object Object],[object Object],[object Object]

Combination of surgery and chemotherapy and the role of targeted agents in the treatment of patients with colorectal liver metastases: recommendations from an expert panel on behalf of the European Colorectal Metastases Treatment Group Ann. Onc., January 19, 2009; (2009) ,[object Object],[object Object]

Management of Liver Metastasis: Patient Selection Non Colorectal / Non NET Liver Metastasis ,[object Object],[object Object],[object Object],[object Object]

Hepatic Resection for Noncolorectal Nonendocrine Liver Mets Analysis of 1452 Patients and Development of a Prognostic Model :Paul Brousse Hospital Villejuif, France ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Adam et al Ann Surg 2006,

Proposal of criteria to select candidates with colorectal liver metastases for hepatic resection: comparison of our scoring system to the positive number of risk factors. Nagashima I , Takada T , Adachi M , Nagawa H , Muto T , Okinaga K . ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],World J Gastroenterol. 2006

Proposal of criteria to select candidates with colorectal liver metastases for hepatic resection: comparison of our scoring system to the positive number of risk factors. Nagashima I , Takada T , Adachi M , Nagawa H , Muto T , Okinaga K . ,[object Object],[object Object],[object Object],[object Object],World J Gastroenterol. 2006

Results of R0 Resection for Colorectal Liver Metastases Associated With Extrahepatic Disease Elias D et al ( France) Ann Surg Oncol 2004 ,[object Object],[object Object],[object Object]

Expanding Criteria for Resectability of Colorectal Liver Metastases Timothy M. Pawlik, Richard D. Schulick, Michael A. Choti John Hopkins The Oncologist, 2008; ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Neuroendocrine hepatic metastases: does aggressive management improve survival Touzios JG , Kiely JM , Pitt SC , Rilling WS , Quebbeman EJ , Wilson SD , Pitt HA . Wisconsin Ann Surg. 2005 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hepatic Resection for Noncolorectal Nonendocrine Liver Mets Analysis of 1452 Patients and Development of a Prognostic Model :Paul Brousse Hospital Villejuif, France Adam et al Ann Surg 2006,

Management of Liver Metastasis: Patient Selection Non Colorectal / Non NET Liver Metastasis ,[object Object]

Comparison with colorectal metastasis ,[object Object],[object Object],[object Object]

COLORECTAL AND NEUROENDOCRINE ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object]

Issues in NCNN ,[object Object],[object Object]

Series summarizing multiple tumor types ,[object Object],[object Object],[object Object],[object Object]

The MSKCC Experience ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object]

Disease free interval and survival

Series focusing on one tumor type- SARCOMAS ,[object Object],[object Object],[object Object],[object Object],[object Object]

Resection Vs. other treatment for sarcomas

Melanomas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management of Liver Metastasis: Patient Selection Non Colorectal / Non NET Liver Metastasis ,[object Object],Weitz et al. Ann Surg 2005

[object Object],[object Object],[object Object],Breast

Ablation in Breast metastases ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Specific Features of Breast Metastases ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object]

Gastric and Pancreatic cancer ,[object Object],[object Object],[object Object]

Germ cell tumors ,[object Object],[object Object],[object Object],[object Object]

Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer ,[object Object],[object Object],[object Object],[object Object],Arru M ,et al Italy, World J Surg. 2008

Results of R0 Resection for Colorectal Liver Metastases Associated With Extrahepatic Disease Elias D et al ( France) Ann Surg Oncol 2004 ,[object Object],[object Object],[object Object],[object Object],[object Object]

A Nomogram for Predicting Disease-specific Survival After Hepatic Resection for Metastatic Colorectal Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],Ann Surg. 2008;247(2):282-287

Tables for: A Nomogram for Predicting Disease-specific Survival After Hepatic Resection for Metastatic Colorectal Cancer [Ann Surg. 2008;247(2):282-287.

Proposal of criteria to select candidates with colorectal liver metastases for hepatic resection: comparison of our scoring system to the positive number of risk factors. Nagashima I , Takada T , Adachi M , Nagawa H , Muto T , Okinaga K . ,[object Object],[object Object],World J Gastroenterol. 2006

Management of the hepatic lymph nodes during resection of liver metastases from colorectal cancer: a systematic review Gurusamy KS , Imber C , Davidson BR . ,[object Object],[object Object],HPB Surg. 2008;2008:684150

Management of the hepatic lymph nodes during resection of liver metastases from colorectal cancer: a systematic review Gurusamy KS , Imber C , Davidson BR . ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],HPB Surg. 2008;2008:684150

Management of Liver Metastasis: Patient Selection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management of Liver Metastasis: Patient Selection in CRC Liver Metastases ,[object Object]

Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Abdalla EK , et.al. HoustonAnn Surg. 2004 ,[object Object]

Neuroendocrine hepatic metastases: does aggressive management improve survival Touzios JG , Kiely JM , Pitt SC , Rilling WS , Quebbeman EJ , Wilson SD , Pitt HA . Wisconsin Ann Surg. 2005 ,[object Object]

Resection versus no intervention or other surgical interventions for colorectal cancer liver metastases. Al- Asfoor A , Fedorowicz Z , Lodge M . ,[object Object],Cochrane Database Syst Rev. 2008 Apr

Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer Arru M ,et al Italy, World J Surg. 2008 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management Of Liver M E T A S T A S I S Patient Selection

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