Clinical Challenges in Hepatobiliary Surgery: Metachronous Colorectal Liver Metastasis

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 14 February 2022

⏱️ 51 minutes

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Summary

Description: Metachronous colorectal liver metastasis (CRLM) is a complex clinical situation requiring multidisciplinary management. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we discuss a patient presenting with metachronous CRLM and how management may change with varying clinical scenarios.

Learning Objectives: In this episode, we review the initial workup and pre-operative considerations in a patient presenting with metachronous CRLM. We discuss key aspects of resectability of CRLM, including physiologic and hepatic fitness, biology of the disease, and technical considerations. We review the timing and common regimens of systemic treatment for differing clinical scenarios, as well as when adjuncts to treatment may be useful (e.g., portal venous embolization). Finally, we highlight important aspects of intraoperative and postoperative management.

Hosts:
Timothy Vreeland, MD, FACS (@vreelant) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center

Daniel Nelson, DO, FACS (@DWNelsonHPB) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center

Connor Chick, MD (@connor_chick) is a PGY-5 General Surgery resident at Brooke Army Medical Center

Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-4 General Surgery resident at Brooke Army Medical Center

Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-3 General Surgery resident at Brooke Army Medical Center

Links to Papers Referenced in this Episode:

NCCN Guidelines for Colon Cancer
https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf

Mutation Status of RAS, TP53, and SMAD4 is Superior to Mutation Status of RAS Alone for Predicting Prognosis after Resection of Colorectal Liver Metastases. Clin Cancer Res. 2019 Oct 1;25(19):5843-5851. doi: 10.1158/1078-0432.CCR-19-0863. Epub 2019 Jun 20. PMID: 31221662; PMCID: PMC6774854.
https://pubmed.ncbi.nlm.nih.gov/31221662/

Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013 Nov;14(12):1208-15. doi: 10.1016/S1470-2045(13)70447-9. Epub 2013 Oct 11. PMID: 24120480.
https://pubmed.ncbi.nlm.nih.gov/24120480/

FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of the open-label, phase 3 TRIBE study. Lancet Oncol. 2015 Oct;16(13):1306-15. doi: 10.1016/S1470-2045(15)00122-9. Epub 2015 Aug 31. PMID: 26338525.
https://pubmed.ncbi.nlm.nih.gov/26338525/

Phase II Randomized Trial of Sequential or Concurrent FOLFOXIRI-Bevacizumab Versus FOLFOX-Bevacizumab for Metastatic Colorectal Cancer (STEAM). Oncologist. 2019 Jul;24(7):921-932. doi: 10.1634/theoncologist.2018-0344. Epub 2018 Dec 14. PMID: 30552157; PMCID: PMC6656450.
https://pubmed.ncbi.nlm.nih.gov/30552157/

Bevacizumab plus mFOLFOX-6 or FOLFOXIRI in patients with initially unresectable liver metastases from colorectal cancer: the OLIVIA multinational randomised phase II trial. Ann Oncol. 2015 Apr;26(4):702-708. doi: 10.1093/annonc/mdu580. Epub 2014 Dec 23. PMID: 25538173.
https://pubmed.ncbi.nlm.nih.gov/25538173/

Recommended Additional Podcasts on CRLM:

The AHPBA Podcast:
1. Episode 1: Dr. Jean Nicolas Vauthey - Colorectal Liver Metastases (https://podcasts.apple.com/us/podcast/episode-1-dr-jean-nicolas-vauthey-colorectal-liver/id1501441845?i=1000467381474)
2. Episode 12:Dr D'Angelica - Colorectal Liver Metastases and Hepatic Artery Infusion Pumps (https://podcasts.apple.com/us/podcast/episode-12-dr-dangelica-colorectal-liver-metastases/id1501441845?i=1000521718184)
Behind the Knife:
1. Surgical Oncology-Hepatic Artery Infusion Pump (https://podcasts.apple.com/ye/podcast/surgical-oncology-hepatic-artery-infusion-pump/id980990143?i=1000525833877)

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Transcript

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0:00.0	Welcome back, too!
0:01.2	I'll be the answer!
0:03.0	Two pizzas.
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0:11.5	costing just £139.
0:13.5	So where can you save over 50% on your pizza?
0:16.6	Can't stop that!
0:18.4	Time's up! You're right!
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0:21.2	So come on down to Aldi,
0:23.1	which cheapest supermarket of the year?
0:24.8	Other supermarkets may sell on-brand products at different prices
0:27.2	for full details, see Aldi.co.uk forward slash swap.
0:35.8	Behind the knife, the surgery podcast.
0:38.9	Relevant and engaging content to sign to help you,
0:42.0	dominate the day.
0:43.2	All right, so welcome to Behind the Knife,
0:55.4	we're the HPB team.
0:57.0	I'm Dan Nelson, and I'm joined by my co-host, Tim Vreland,
1:01.6	Lexi Adams, and Connor Chick,
1:03.7	from Brook Army Medical Center.
	...

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