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Simultaneous parenchyma-preserving liver resection, cytoreductive surgery and intraperitoneal chemotherapy for stage IV colorectal cancer

Luis Abreu De Carvalho (UGent) , VINCENZO SCUDERI (UGent) , HENDRIK MAES (UGent) , P Cupo, B Geerts, Mieke Van Bockstal (UGent) , Félix Gremonprez (UGent) , Wouter Willaert (UGent) , Piet Pattyn (UGent) , Roberto Troisi (UGent) , et al.
(2015) ACTA CHIRURGICA BELGICA. 115(4). p.261-267
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Abstract
Background : The outcome of stage IV colorectal cancer (CRC) has improved with modern systemic therapy. However, the concomitant presence of liver metastases (LM) and peritoneal carcinomatosis (PC) remains associated with a dismal prognosis and surgery in this context remains exceptional. Methods : Stage IV CRC patients with LM and PC undergoing simultaneous cytoreductive surgery, intraperitoneal chemotherapy (IPC) and liver resection/ablation were identified from prospectively collected databases. We assessed response to neoadjuvant chemotherapy (NACT), postoperative complications, progression free survival (PFS), and overall survival (OS). Results : Twenty-one patients with resectable disease were treated between 2007 and 2014. In 16 patients (76%), NACT was administered and tumour response defined their selection. The remaining 5 (24%) were selected according to the pattern of recurrence. Median peritoneal cancer index was 5 (range : 3-10.5). Liver surgery included 34 wedge resections, 5 ablations and one bisectionectomy to treat a total of 45 hepatic lesions with a median of 2 per patient (range : 1-2) and a median size of 1.35 cm (range : 0.8-2). Tumour regression grade 4 (fibrosis but residual cancer cells predominate) was seen in 50% of the resected metastases after NACT. Median hospital stay was 17 days (range : 14-24); severe morbidity (Clavien-Dindo grade 3-4) occurred in 24% and no perioperative mortality (0-90 days) was recorded. The median OS was 44 months (range : 31-57) while the median PFS was 10 months (range : 8-12). Conclusion : Combined parenchyma-preserving liver resection, cytoreductive surgery and IPC in patients with LM and PC from CRC can be performed safely and results in promising mid-term overall survival.
Keywords
OUTCOMES, SURVIVAL, DISEASE, NEOADJUVANT CHEMOTHERAPY, HEPATIC RESECTION, SYNCHRONOUS PERITONEAL CARCINOMATOSIS, METASTASES, TUMOR, HIPEC, ORIGIN

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MLA
Abreu De Carvalho, Luis et al. “Simultaneous Parenchyma-preserving Liver Resection, Cytoreductive Surgery and Intraperitoneal Chemotherapy for Stage IV Colorectal Cancer.” ACTA CHIRURGICA BELGICA 115.4 (2015): 261–267. Print.
APA
Abreu De Carvalho, L., SCUDERI, V., MAES, H., Cupo, P., Geerts, B., Van Bockstal, M., Gremonprez, F., et al. (2015). Simultaneous parenchyma-preserving liver resection, cytoreductive surgery and intraperitoneal chemotherapy for stage IV colorectal cancer. ACTA CHIRURGICA BELGICA, 115(4), 261–267.
Chicago author-date
Abreu De Carvalho, Luis, VINCENZO SCUDERI, HENDRIK MAES, P Cupo, B Geerts, Mieke Van Bockstal, Félix Gremonprez, et al. 2015. “Simultaneous Parenchyma-preserving Liver Resection, Cytoreductive Surgery and Intraperitoneal Chemotherapy for Stage IV Colorectal Cancer.” Acta Chirurgica Belgica 115 (4): 261–267.
Chicago author-date (all authors)
Abreu De Carvalho, Luis, VINCENZO SCUDERI, HENDRIK MAES, P Cupo, B Geerts, Mieke Van Bockstal, Félix Gremonprez, Wouter Willaert, Piet Pattyn, Roberto Troisi, and Wim Ceelen. 2015. “Simultaneous Parenchyma-preserving Liver Resection, Cytoreductive Surgery and Intraperitoneal Chemotherapy for Stage IV Colorectal Cancer.” Acta Chirurgica Belgica 115 (4): 261–267.
Vancouver
1.
Abreu De Carvalho L, SCUDERI V, MAES H, Cupo P, Geerts B, Van Bockstal M, et al. Simultaneous parenchyma-preserving liver resection, cytoreductive surgery and intraperitoneal chemotherapy for stage IV colorectal cancer. ACTA CHIRURGICA BELGICA. 2015;115(4):261–7.
IEEE
[1]
L. Abreu De Carvalho et al., “Simultaneous parenchyma-preserving liver resection, cytoreductive surgery and intraperitoneal chemotherapy for stage IV colorectal cancer,” ACTA CHIRURGICA BELGICA, vol. 115, no. 4, pp. 261–267, 2015.
@article{7036730,
  abstract     = {Background : The outcome of stage IV colorectal cancer (CRC) has improved with modern systemic therapy. However, the concomitant presence of liver metastases (LM) and peritoneal carcinomatosis (PC) remains associated with a dismal prognosis and surgery in this context remains exceptional. 
Methods : Stage IV CRC patients with LM and PC undergoing simultaneous cytoreductive surgery, intraperitoneal chemotherapy (IPC) and liver resection/ablation were identified from prospectively collected databases. We assessed response to neoadjuvant chemotherapy (NACT), postoperative complications, progression free survival (PFS), and overall survival (OS). 
Results : Twenty-one patients with resectable disease were treated between 2007 and 2014. In 16 patients (76%), NACT was administered and tumour response defined their selection. The remaining 5 (24%) were selected according to the pattern of recurrence. Median peritoneal cancer index was 5 (range : 3-10.5). Liver surgery included 34 wedge resections, 5 ablations and one bisectionectomy to treat a total of 45 hepatic lesions with a median of 2 per patient (range : 1-2) and a median size of 1.35 cm (range : 0.8-2). Tumour regression grade 4 (fibrosis but residual cancer cells predominate) was seen in 50% of the resected metastases after NACT. Median hospital stay was 17 days (range : 14-24); severe morbidity (Clavien-Dindo grade 3-4) occurred in 24% and no perioperative mortality (0-90 days) was recorded. The median OS was 44 months (range : 31-57) while the median PFS was 10 months (range : 8-12). 
Conclusion : Combined parenchyma-preserving liver resection, cytoreductive surgery and IPC in patients with LM and PC from CRC can be performed safely and results in promising mid-term overall survival.},
  author       = {Abreu De Carvalho, Luis and SCUDERI, VINCENZO and MAES, HENDRIK and Cupo, P and Geerts, B and Van Bockstal, Mieke and Gremonprez, Félix and Willaert, Wouter and Pattyn, Piet and Troisi, Roberto and Ceelen, Wim},
  issn         = {0001-5458},
  journal      = {ACTA CHIRURGICA BELGICA},
  keywords     = {OUTCOMES,SURVIVAL,DISEASE,NEOADJUVANT CHEMOTHERAPY,HEPATIC RESECTION,SYNCHRONOUS PERITONEAL CARCINOMATOSIS,METASTASES,TUMOR,HIPEC,ORIGIN},
  language     = {eng},
  number       = {4},
  pages        = {261--267},
  title        = {Simultaneous parenchyma-preserving liver resection, cytoreductive surgery and intraperitoneal chemotherapy for stage IV colorectal cancer},
  volume       = {115},
  year         = {2015},
}

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