Clinical Challenges in Hepatobiliary Surgery: Bilateral Colorectal Liver Metastasis

Surgical resection of bilateral colorectal liver metastasis (CLM) can pose a significant challenge to even the most experienced HPB surgeon. Is surgical resection justified, if so, in which patients? What’s the best surgical approach for curative intent resection of all lesions, and does ablation play a role? In this episode from the HPB team at Behind the Knife, listen in on the discussion about the surgical management of patients with bilateral colorectal liver metastasis.

Hosts
Anish J. Jain MD (@anishjayjain) is a T32 Research Fellow at the University of Texas MD Anderson Cancer Center within the Department of Surgical Oncology.

Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center. 

Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center

Learning Objectives:
·      Develop an understanding of patient selection for surgical resection of bilateral colorectal liver metastasis (CLM).
·      Develop an understanding of the use of Two Stage Hepatectomy (TSH) versus Parenchymal Sparing Hepatectomy (PSH) in the treatment of bilateral CLM.
·      Develop an understanding of if and when to use ablative procedures for resection of bilateral CLM.
·      Develop an understanding of selection and management of patients who suffer recurrence after resection of bilateral CLM.

Suggested Readings
·      Omichi K, Shindoh J, Cloyd JM, Mizuno T, Chun YS, Conrad C, Aloia TA, Tzeng CD, Vauthey JN. Liver resection is justified for patients with bilateral multiple colorectal liver metastases: A propensity-score-matched analysis. Eur J Surg Oncol. 2018 Jan;44(1):122-129. doi: 10.1016/j.ejso.2017.11.006. Epub 2017 Nov 24. PMID: 29208318; PMCID: PMC5742306.
https://pubmed.ncbi.nlm.nih.gov/29208318/

·      Kawaguchi Y, Kopetz S, Tran Cao HS, Panettieri E, De Bellis M, Nishioka Y, Hwang H, Wang X, Tzeng CD, Chun YS, Aloia TA, Hasegawa K, Guglielmi A, Giuliante F, Vauthey JN. Contour prognostic model for predicting survival after resection of colorectal liver metastases: development and multicentre validation study using largest diameter and number of metastases with RAS mutation status. Br J Surg. 2021 Aug 19;108(8):968-975. doi: 10.1093/bjs/znab086. PMID: 33829254; PMCID: PMC8378514.
https://pubmed.ncbi.nlm.nih.gov/33829254/

·      Nishioka Y, Paez-Arango N, Boettcher FO, Kawaguchi Y, Newhook TE, Chun YS, Tzeng CD, Tran Cao HS, Lee JE, Vreeland TJ, Vauthey JN. Neither Surgical Margin Status nor Somatic Mutation Predicts Local Recurrence After R0-intent Resection for Colorectal Liver Metastases. J Gastrointest Surg. 2022 Apr;26(4):791-801. doi: 10.1007/s11605-021-05173-0. Epub 2021 Nov 1. PMID: 34725784.
https://pubmed.ncbi.nlm.nih.gov/34725784/

·      Passot G, Chun YS, Kopetz SE, Zorzi D, Brudvik KW, Kim BJ, Conrad C, Aloia TA, Vauthey JN. Predictors of Safety and Efficacy of 2-Stage Hepatectomy for Bilateral Colorectal Liver Metastases. J Am Coll Surg. 2016 Jul;223(1):99-108. doi: 10.1016/j.jamcollsurg.2015.12.057. Epub 2016 Jan 18. PMID: 26968325; PMCID: PMC4925205.
https://pubmed.ncbi.nlm.nih.gov/26968325/

·      Donadon M, Cescon M, Cucchetti A, Cimino M, Costa G, Pesi B, Ercolani G, Pinna AD, Torzilli G. Parenchymal-Sparing Surgery for the Surgical Treatment of Multiple Colorectal Liver Metastases Is a Safer Approach than Major Hepatectomy Not Impairing Patients' Prognosis: A Bi-Institutional Propensity Score-Matched Analysis. Dig Surg. 2018;35(4):342-349. doi: 10.1159/000479336. Epub 2017 Oct 14. PMID: 29032372.
https://pubmed.ncbi.nlm.nih.gov/29032372/

·      Lillemoe HA, Kawaguchi Y, Passot G, Karagkounis G, Simoneau E, You YN, Mehran RJ, Chun YS, Tzeng CD, Aloia TA, Vauthey JN. Surgical Resection for Recurrence After Two-Stage Hepatectomy for Colorectal Liver Metastases Is Feasible, Is Safe, and Improves Survival. J Gastrointest Surg. 2019 Jan;23(1):84-92. doi: 10.1007/s11605-018-3890-y. Epub 2018 Aug 6. PMID: 30084064; PMCID: PMC6329635.
https://pubmed.ncbi.nlm.nih.gov/30084064/

·      Panettieri E, Kim BJ, Kawaguchi Y, Ardito F, Mele C, De Rose AM, Vellone M, Chun YS, Tzeng CD, Aloia TA, Giuliante F, Vauthey JN. Survival by Number and Sites of Resections of Recurrence after First Curative Resection of Colorectal Liver Metastases. J Gastrointest Surg. 2022 Dec;26(12):2503-2511. doi: 10.1007/s11605-022-05456-0. Epub 2022 Sep 20. PMID: 36127553.
https://pubmed.ncbi.nlm.nih.gov/36127553/

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