Journal Review in Hepatobiliary Surgery: Genomics of Colorectal Liver Metastasis

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 13 June 2022

⏱️ 47 minutes

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Summary

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 review the genomics of CRLM, discuss a journal article investigating the frequency and impact of these mutations on survival in patients with stage IV disease, and interview the senior author Dr. Jean-Nicholas Vauthey about this research and his career in HPB.

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

Guest:
Jean-Nicholas Vauthey, MD (@VautheyMD) is a Professor of Surgical Oncology, Chief of HPB, and Dallas/Fort Worth Living Legend Chair for Cancer Research at MD Anderson. He is the Principal Investigator of the study discussed in the episode in addition to numerous other articles describing the genomics of colorectal liver metastases.

Learning Objectives: In this episode, we review basic mutations found in metastatic colorectal cancer and broadly discuss these in a clinical context. We review a journal article from Kawaguchi et al. in which authors analyze prognostic relevance of signaling pathways in patients undergoing resection of CRLM, later validated in an external cohort of unresected patients. We conduct an interview with the senior author of the study regarding relevant methodologic details, next steps in his research, and how to apply this information now and in the future to the care of patients with CRLM.

Links to Papers Referenced in this Episode:
Journal Article:
Kawaguchi Y, Kopetz S, Kwong L, Xiao L, Morris JS, Tran Cao HS, Tzeng CD, Chun YS, Lee JE, Vauthey JN. Genomic Sequencing and Insight into Clinical Heterogeneity and Prognostic Pathway Genes in Patients with Metastatic Colorectal Cancer. J Am Coll Surg. 2021 Aug;233(2):272-284.e13. doi: 10.1016/j.jamcollsurg.2021.05.027. Epub 2021 Jun 7. PMID: 34111531; PMCID: PMC8666966.

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)

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

Transcript

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0:00.0	Hi everyone, welcome back to another HPV episode of Behind the Knife, where your HPV
0:27.2	team from Brook Army Medical Center and William Beaumont and El Paso. Today's episode will be
0:32.5	complimentary to our last episode on Metacranus colorectal liver mitts. So if you hadn't had a
0:37.2	chance to check that one out, we'd highly suggest you listen to that one first. But we're extremely
0:41.8	excited to bring you this journal club episode today, discussing mutations in colorectal liver
0:46.3	metastases. We'll have a team discussion of the article first followed by an interview at the
0:51.2	April IHPBA meeting with one of the foremost experts in the field and senior author, Dr.
0:56.4	Jean Nicolas Voté. So the specific article we'll be discussing is called genomic sequencing and
1:02.0	insight into clinical heterogeneity and prognostic pathway genes in patients with metastatic colorectal
1:07.4	cancer. And the first author was Dr. Kawaguchi and the senior author, as we mentioned, was Dr. Jean
1:13.6	Nicolas Voté. Dr. Nelson, do you want to give us a kind of bird's eye view of the article and the
1:20.0	intent behind the article to get us started? So I think to introduce this article, the best way to
1:25.3	think about this is that right now metastatic colon cancer is classified into a single risk group
1:31.8	of stage four patients. Taken together, those patients have a five-year overall survival around 15%.
1:39.2	But we know that amongst these patients, there's a wide range of clinical behaviors with patients
1:45.7	that undergo a resection of liver-only colorectal metastases having survival up to 40 to 60%.
1:53.2	And what we've come to learn is that these tumors are genomically heterogeneous. They have a wide
2:00.4	range of mutations within them. And we've been able to start to approve data on the different
2:08.5	mutations that are occurring within these metastases amongst different patients. And now with
2:14.1	getting all of this data together, and the Anderson in this paper was able to evaluate the frequency
2:20.7	of these mutations and really look at mutations within these signaling pathways, how they are
2:28.3	or contribute to prognostication amongst these stage four patients. So with that, Beth,
	...

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