Resection of Colorectal Liver metastasis (CRLM)

The most common site of spread from colon cancer is liver. Many patients present with liver metastasis at the time of their presentation with colon cancer. With advent of newer treatment modalities, liver metastasis from colon cancer has improved survival.

At St Jospeh Hospital state of the art liver cancer service , several options are available. The most frequent treatments offered to our patients here at St. Joseph hosptial includes surgical resection, local tumor ablation (ie, radiofrequency ablation [RFA]), Transarterial chemoembolization, and Intratumoral radiation beads. Liver Resection offers the greatest likelihood of cure for the patients.

If you are diagnosed with liver metastasis we suggest immediate surgical resection rather than initial chemotherapy if you are medically fit patients and the tumor is confined to either right or left liver lobe. For patients with a good performance status who have more than four metastases (unless all are localized to a single lobe), radiographic suspicion for portal node involvement, or bilobar disease (ie, tumor involving any segments of the left and right hemi-liver), we suggest initial systemic chemotherapy followed by surgical reevaluation

The optimal chemotherapy regimen is not established. We consider the following combinations to represent reasonable choices: FOLFOX , FOLFOXIRI , or FOLFIRI plus either cetuximab or panitumumab

For patients who have hepatic metastases at initial presentation, the optimal timing of liver resection is uncertain. We suggest one-stage surgery, if feasible (Grade 2C). If not feasible, resection of liver metastases can follow six to eight weeks after resection of the primary tumor.

       

Liver Resection means removal of a portion of the liver. This is done mainly for malignant cancers of the liver. Majority of liver tumors are metastatic (developed in another organ, then migrated to the liver). The majority of liver metastases come from the colon. Successful resection of liver tumors in absence of metastasis confers a long term survival with 5-year survival as high as 70%.

 

All patients who presents to us are carefully evaluated for liver resection.. Oftentimes , complete removal of liver cancer often is not possible because the cancer is large or is present in both right and left side of the liver or has spread to other parts of the liver or the body. Also, the liver may be damaged because of other conditions like liver cirrhosis.. Surgeons try to remove as much of the tumor as possible while keeping enough of the liver to function.

 

In West Coast of Florida, we are the only institute to provide advanced technology of Yitrium, Radiofrequency Ablation and Trans Arterial ChemoEmbolization for unresectable liver cancers all under one roof. Through our multidisciplinary team, we evaulates your case including radiologic imaging and recommend the best treatment approach available to you.

Our Hepatobiliary surgeons will carfully evaluate your condition and offer you liver resection through key hole approach or even robotic if feasable.

 

At St. Joseph Liver Cancer center, we use the state of the art latest technology to perform liver resection using either minimally invasive (laparoscopic or robotic ) liver surgery or traditional (open) liver surgery.

Dr. Sukharamwala and Dr. Ecchevaria are among the very experienced in the United States at minimally invasive liver surgery. This confers several advantages in reducing the pain, scarring, hospital stay and recovery time. 

You can expect to stay in the hospital for 5-7 days.

If you have a major liver resection, we would generally observe you in the ICU for overnight to make sure you are recovering well.

First day after surgery, we will transfer to our special surgical floor where all our Liver, Pancreas and Foregut surgery patients are admitted. This ensures that the nurse taking care of your recovery is knows well what to expect.

You will get aggressive breathing treatment, physical therapy. We may start you on Ice chips and gradually as you tolerate oral intake, we will start you on clear liquid diet. Your Diet will be advanced progressively to regular diet as you recuperate well and your bowel function return with passing flatulence and bowel movements.

Often times, your bowels may be slow to resume due to a condition called postoperative ileus. Post operative ileus is common condition after a major opearation where your bowel are slow to resume the function. As a result you may develop nausea, vomiting and may require insertion of Nasal-gastric ( nose to stomach ) tube.

 

A drain may be present in the abdomen which will be removed if your recovery is as expected.

 

At your discharge, you will be given a complete discharge instruction, pain medication prescription and contact information in case of any post operative issues.

We will see you back in our office for post operative check up in 5-7 days.

A few complication that are associated with this procedure include but not limited are

Bile leak

Wound infection,

Bleeding.

Pneumonia,

General Anesthesia complications.

Information

The most common site of spread from colon cancer is liver. Many patients present with liver metastasis at the time of their presentation with colon cancer. With advent of newer treatment modalities, liver metastasis from colon cancer has improved survival.

At St Jospeh Hospital state of the art liver cancer service , several options are available. The most frequent treatments offered to our patients here at St. Joseph hosptial includes surgical resection, local tumor ablation (ie, radiofrequency ablation [RFA]), Transarterial chemoembolization, and Intratumoral radiation beads. Liver Resection offers the greatest likelihood of cure for the patients.

Our opinion

If you are diagnosed with liver metastasis we suggest immediate surgical resection rather than initial chemotherapy if you are medically fit patients and the tumor is confined to either right or left liver lobe. For patients with a good performance status who have more than four metastases (unless all are localized to a single lobe), radiographic suspicion for portal node involvement, or bilobar disease (ie, tumor involving any segments of the left and right hemi-liver), we suggest initial systemic chemotherapy followed by surgical reevaluation

The optimal chemotherapy regimen is not established. We consider the following combinations to represent reasonable choices: FOLFOX , FOLFOXIRI , or FOLFIRI plus either cetuximab or panitumumab

For patients who have hepatic metastases at initial presentation, the optimal timing of liver resection is uncertain. We suggest one-stage surgery, if feasible (Grade 2C). If not feasible, resection of liver metastases can follow six to eight weeks after resection of the primary tumor.

Treatment

       

Liver Resection means removal of a portion of the liver. This is done mainly for malignant cancers of the liver. Majority of liver tumors are metastatic (developed in another organ, then migrated to the liver). The majority of liver metastases come from the colon. Successful resection of liver tumors in absence of metastasis confers a long term survival with 5-year survival as high as 70%.

 

All patients who presents to us are carefully evaluated for liver resection.. Oftentimes , complete removal of liver cancer often is not possible because the cancer is large or is present in both right and left side of the liver or has spread to other parts of the liver or the body. Also, the liver may be damaged because of other conditions like liver cirrhosis.. Surgeons try to remove as much of the tumor as possible while keeping enough of the liver to function.

 

In West Coast of Florida, we are the only institute to provide advanced technology of Yitrium, Radiofrequency Ablation and Trans Arterial ChemoEmbolization for unresectable liver cancers all under one roof. Through our multidisciplinary team, we evaulates your case including radiologic imaging and recommend the best treatment approach available to you.

Our Hepatobiliary surgeons will carfully evaluate your condition and offer you liver resection through key hole approach or even robotic if feasable.

 

At St. Joseph Liver Cancer center, we use the state of the art latest technology to perform liver resection using either minimally invasive (laparoscopic or robotic ) liver surgery or traditional (open) liver surgery.

Dr. Sukharamwala and Dr. Ecchevaria are among the very experienced in the United States at minimally invasive liver surgery. This confers several advantages in reducing the pain, scarring, hospital stay and recovery time. 

Post operative care

You can expect to stay in the hospital for 5-7 days.

If you have a major liver resection, we would generally observe you in the ICU for overnight to make sure you are recovering well.

First day after surgery, we will transfer to our special surgical floor where all our Liver, Pancreas and Foregut surgery patients are admitted. This ensures that the nurse taking care of your recovery is knows well what to expect.

You will get aggressive breathing treatment, physical therapy. We may start you on Ice chips and gradually as you tolerate oral intake, we will start you on clear liquid diet. Your Diet will be advanced progressively to regular diet as you recuperate well and your bowel function return with passing flatulence and bowel movements.

Often times, your bowels may be slow to resume due to a condition called postoperative ileus. Post operative ileus is common condition after a major opearation where your bowel are slow to resume the function. As a result you may develop nausea, vomiting and may require insertion of Nasal-gastric ( nose to stomach ) tube.

 

A drain may be present in the abdomen which will be removed if your recovery is as expected.

 

At your discharge, you will be given a complete discharge instruction, pain medication prescription and contact information in case of any post operative issues.

We will see you back in our office for post operative check up in 5-7 days.

Complications

A few complication that are associated with this procedure include but not limited are

Bile leak

Wound infection,

Bleeding.

Pneumonia,

General Anesthesia complications.