Consideration of tumor genomics in the management of synchronous colorectal liver metastases.

Colorectal cancer with synchronous metastatic disease to the liver represents a particular challenge in multidisciplinary cancer care. Optimal management involves a combination of surgical resection, systemic, regional and/or targeted therapies; however, the order of and timing of specific therapies requires a nuanced understanding of the disease biology including tumor genomics. In the following article, we conducted a narrative review of the literature to critically examine existing data on the impact of tumor genomics in synchronous colorectal liver metastasis management.

Locoregional Treatment Options for Locally Advanced Intrahepatic Cholangiocarcinoma.

Intrahepatic cholangiocarcinoma (ICC) is an aggressive primary liver malignancy. Although surgical resection remains the standard of care, most patients present with either metastatic or locally advanced, unresectable disease. Although effective systemic therapy is paramount in these situations, locoregional tumor control frequently delays liver-related complications and mortality.

Long-Term Outcomes of Patients Undergoing Two-Stage Hepatectomy For Extensive Colorectal Liver Metastasis Treated With Perioperative Hepatic Artery and Systemic Chemotherapy.

Objective: This study analyzed outcomes and clinical differences between patients who completed or failed TSH (cTSH or fTSH), and evaluated predictive factors for cTSH.

Background: Two-stage hepatectomy (TSH) is a well-recognized treatment for extensive colorectal liver metastases (CRLM).

Methods: A retrospective review of a prospective database identified patients who underwent TSH for extensive CRLM not amenable to a single resection.

The colorectal liver metastasis growth pattern phenotype is not dependent on genotype.

Background: The histopathological growth patterns (HGPs) of colorectal cancer liver metastases broadly classify patients into two groups post-liver metastasectomy, with encapsulated HGP indicating a more favourable prognosis. The potential association between HGPs and specific mutations is poorly understood.

Methods: Using next-generation sequencing data of 461 resected patients (104 patients with encapsulated versus 357 patients with non-encapsulated HGP), 19 putative colorectal cancer driver genes, tumour mutational burden (TMB), and microsatellite instability (MSI) or POLE mediated hypermutation were compared.

Data Extraction and Curation from Radiology Reports for Pancreatic Cyst Surveillance Using Large Language Models.

Introduction: Manual curation of radiographic features in pancreatic cyst registries for data abstraction and longitudinal evaluation is time consuming and limits widespread implementation. We examined the feasibility and accuracy of using large language models (LLMs) to extract clinical variables from radiology reports.

Methods: A single center retrospective study included patients under surveillance for pancreatic cysts.

Histologic- and Genomic-Directed Adjuvant Therapy for Ampullary Adenocarcinoma: A Hidden Genome-Derived Analysis.

Background: The benefit of adjuvant chemotherapy (AC) for ampullary adenocarcinoma is unclear. The Hidden Genome model classifies prognostic subtypes with greater accuracy than standard histologic classification (intestinal [INT] vs pancreatobiliary [PB]), but its predictive capacity to guide the use of AC remains unstudied.

Methods: We applied the Hidden Genome model to an international cohort of 183 patients with resected ampullary adenocarcinoma who underwent genomic sequencing.

Precision in Liver Surgery: A Comparative Analysis of Volumetry Techniques.

Background: Future liver remnant volume (FLRV) is a critical determinant of safety for hepatectomy. This study assesses concordance between imaging-based measured FLRV (mFLRV), and body surface area (BSA)-based standardized FLRV (sFLRV), and their association with post-hepatectomy complications.

Materials And Methods: All major hepatectomy between 1999 and 2021 were assessed for agreement between mFLRV and sFLRV using concordance correlation coefficient (CCC).

Combined Portal and Hepatic Vein Embolization Produces Greater Hypertrophy than Portal Vein Embolization Alone with Similar Post-Hepatectomy Outcomes and is not Impacted by Hepatic Artery Infusion Chemotherapy.

Background: Combined portal and hepatic vein embolization (cPVE-HVE) induces hypertrophy of future liver remnant before hepatectomy. We compared liver hypertrophy and post-hepatectomy outcomes between cPVE-HVE and portal vein embolization (PVE) alone.

Patients And Methods: Consecutive patient outcomes after cPVE-HVE and PVE were compared across all pathologies for degree of hypertrophy (DH), kinetic growth rate (KGR), impact of hepatic artery infusion chemotherapy (HAIC), and post-hepatectomy complications at a single center.

Outcomes in Locally Advanced Pancreatic Cancer After Induction Ablative Radiation Therapy and Resection.

Background: Ablative-dose radiotherapy (A-RT) may result in durable local control and encouraging survival for patients with locally advanced pancreatic cancer (LAPC). A subset of patients with LAPC are eligible for exploration after completion of induction chemotherapy and A-RT. Outcomes for this subset of patients are yet to be described.

Natural History of Pancreatic Cyst with Diameter as Solitary Risk Factor.

Background: Multiple pancreatic cyst surveillance guidelines include cyst diameter 3 cm or greater as a worrisome feature prompting surgical referral.

Study Design: This was a single-center retrospective review of patients with pancreatic cysts 3 cm or greater at diagnosis and no other worrisome features. Cyst progression was defined as the development of additional worrisome features, pancreatic cancer diagnosis, or pancreatectomy.

Outcomes of Transarterial Hepatic Embolization versus Yttrium-90 Radioembolization for Treatment of Patients with Hepatocellular Carcinoma >7 cm.

Purpose: To assess and compare the safety, effectiveness, and outcomes of transarterial hepatic embolization (TAE) and transarterial radioembolization (TARE) for the treatment of patients with unresectable hepatocellular carcinoma (HCC) >7 cm.

Materials And Methods: Treatment-naive patients with HCC >7 cm who were treated with TAE or TARE between January 2013 and December 2023 were reviewed in this retrospective study. Nearest neighbor 2:1 propensity score matching was utilized for direct comparison.

The Association Between Surgical Margin Status, Recurrence Patterns, and Oncologic Outcomes in Patients with Colorectal Liver Metastases.

Objective: To enhance understanding of the relationships between margin width, recurrence patterns, recurrence-free survival, and salvage therapy following initial hepatectomy for colorectal liver metastases (CRLM).

Background: The prognostic implications of the technical aspects of CRLM have not been well-characterized.

Methods: A prospective database of 1776 patients who underwent complete resection for CRLM at a single institution (1991-2012) was studied.

Robotic Versus Open Placement of Hepatic Artery Infusion Pumps.

Background: A growing number of centers offer hepatic artery infusion pump (HAIP) chemotherapy for advanced liver malignancies. While small series have demonstrated feasibility of robotic HAIP placement, comparison of outcomes with open placement is lacking. We compared outcomes after robotic versus open HAIP placement.

Adjuvant Cytotoxic Chemotherapy may not be Associated with a Survival Advantage for Resected Intrahepatic Cholangiocarcinoma.

Background: Randomized data suggest improved survival with adjuvant chemotherapy for biliary tract cancers; however, subset analyses of intrahepatic cholangiocarcinoma (IHC) show limited survival benefit. This study evaluated the impact of adjuvant chemotherapy on recurrence patterns and overall survival (OS) in patients with resected IHC.

Methods: Patients who underwent curative-intent resection for IHC were identified within a bi-institutional dataset and the National Cancer Database (NCDB).

Impact of Financial Toxicity on Treatment Adherence and Quality of Life in Pancreatic Cancer.

Purpose: Financial toxicity (FT) is increasingly recognized as a major issue in cancer care. We evaluated the prevalence and risk factors for FT in patients with pancreatic ductal adenocarcinoma (PDAC) and FT associations with treatment adherence and quality of life (QOL).

Methods: A screening questionnaire based on the Comprehensive Score for Financial Toxicity (COST) was implemented at our National Cancer Institute-designated comprehensive cancer center.

Survival of Patients with Resected Microsatellite Instability-High, Mismatch Repair Deficient, and Lynch Syndrome-Associated Pancreatic Ductal Adenocarcinomas.

Background: Pancreatic ductal adenocarcinoma (PDAC) remains a challenging disease due to its aggressiveness, late-stage diagnosis, and limited treatment options. Microsatellite instability-high (MSI-H) cancers are susceptible to immune checkpoint inhibitors. Survival outcomes for patients with MSI-H PDAC are unknown as the disease is rare.

Surgical Site Infections in Simultaneous Colorectal and Liver Resections for Metastatic Colorectal Adenocarcinoma.

Background: Surgical site infections (SSIs) are a major driver of morbidity after combined liver and colorectal surgery for metastatic colorectal cancer. Available literature is inadequate to characterize risk factors and benchmarks for quality improvement.

Methods: Consecutive cases of simultaneous liver and colorectal surgery for colorectal adenocarcinoma from November 2013 through September 2022 were reviewed for SSIs per National Surgical Quality Improvement Program (NSQIP) and National Healthcare Safety Network (NHSN) criteria.

Computed Tomography-Based Radiomics with Machine Learning Outperforms Radiologist Assessment in Estimating Colorectal Liver Metastases Pathologic Response After Chemotherapy.

Objectives: This study was designed to assess computed tomography (CT)-based radiomics of colorectal liver metastases (CRLM), extracted from posttreatment scans in estimating pathologic treatment response to neoadjuvant therapy, and to compare treatment response estimates between CT-based radiomics and radiological response assessment by using RECIST 1.1 and CT morphologic criteria.

Methods: Patients who underwent resection for CRLM from January 2003-December 2012 at a single institution were included.

A NSQIP-Based Randomized Clinical Trial Evaluating Choice of Prophylactic Antibiotics for Pancreaticoduodenectomy.

Surgical site infection is a common complication following pancreaticoduodenectomy and is a major source of postoperative morbidity. Surgical site infection is more common among patients who undergo preoperative biliary instrumentation, likely because of the introduction of intestinal flora into the normally sterile biliary tree. Frequently, bacterial isolates from surgical site infections after pancreaticoduodenectomy demonstrate resistance to the antibiotic agents typically used for surgical prophylaxis, suggesting that broad-spectrum coverage may be beneficial.