Annals of Coloproctology

Volume 25(1); February 2009

Original Article

The Relatioships Between Tumor-related Gene Expression and Tumor Budding, Tumor Nodule and Lymph Node Extracapsular Extension in Colorectal Cancer.: Kang, Hyun Jong , Cho, Hang Joo , Kang, Gi Chang , Kim, Kee Hwan , Kang, Won Kyung , Kim, Ji Il , Park, Jong Kyung , Oh, Seungtack , Kim, Jeong Soo , An, Chang Hyeok; J Korean Soc Coloproctol. 2009;25(1):1-7.; DOI: https://doi.org/10.3393/jksc.2009.25.1.1

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Abstract PDF: PURPOSE
Despite the similar lymph node metastasis observed in patients with advanced colorectal cancer (CRC), there was a different clinical outcome. The relationships between tumor-related gene expression and prognostic factors such as tumor budding, tumor nodule and extracapsular extension (ECE) of lymph nodes in patients with CRC remain unclear yet. The purpose of this study was to evaluate the relationship between expression of molecular markers such as vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), matrix metalloproteinases (MMPs) and E-cadherin and the tumor budding, tumor nodule and ECE of lymph nodes in patients with stage III CRC.
METHODS
The tissue of 87 patients with stage III CRC were investigated for expressions of molecular markers using immunohistochemical methods.
RESULTS
VEGF and MMP-9 expression in tumor tissue were positively associated with the colorectal cancer prognostic factors such as tumor budding, tumor nodule and extracapsular lymph node extension (P<0.05). But, MMP-2, EGF and E-cadherin expression were of no value with regard to them.
CONCLUSION
Our results suggest that molecular markers, in particular VEGF and MMP-9, may provide additional prognostic information regarding tumor budding, ECE and tumor nodule.

Randomized Controlled Trial

Randomized Trial Comparing a Starion(TM) and a Harmonic Scalpel(TM) Hemorrhoidectomy.: Kim, Joo Hyung , Lee, Yong Pyo; J Korean Soc Coloproctol. 2009;25(1):8-13.; DOI: https://doi.org/10.3393/jksc.2009.25.1.8

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Abstract PDF

PURPOSE
The present study was designed to evaluate the efficacy and the outcome when using the Starion(TM) and the Harmonic Scalpel(TM) vessel sealing systems for a sutureless hemorrhoidectomy.
METHODS
This study is a randomized, controlled trial. Patients with Grade 3 and 4 hemorrhoids were categorized into two groups: the Starion(TM) hemorrhoidectomy (30 patients) group and the Harmonic Scalpel(TM) hemorrhoidectomy (30 patients) group. The measures of the primary outcomes were the operating time, the postoperative pain score, and the patient satisfaction score. Secondary outcome criteria included early and delayed complications: postoperative bleeding, anal stenosis, urinary difficulty, and skin tag.
RESULTS
The satisfaction scores 4 wk postoperatively were not significantly different between the two groups (P=0.186). However, the operating time was reduced (P=0.019), the pain score was lower (P=0.009), and the satisfaction score 1 wk postoperatively (P=0.001) was lower in the Starion(TM) hemorrhoidectomy group. In addition, there were no differences in early and delayed postoperative complications between the two groups (all P>0.05).
CONCLUSION
Both methods were found to be surprisingly equivalent in all major aspects analyzed. A Starion(TM) hemorrhoidectomy with submucosal dissection can provide a safe, fast, bloodless, reduced-pain, and low-priced surgical alternative to hemorrhoidal surgery. More studies are needed to determine whether similar favorable results can be attained in patients with more severe, strangulated hemorrhoids.

Citations

Citations to this article as recorded by

Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids
C Simillis, S N Thoukididou, A A P Slesser, S Rasheed, E Tan, P P Tekkis
British Journal of Surgery.2015; 102(13): 1603. CrossRef

Original Articles

Dual Therapy and Triple Therapy of Prophylactic Antibiotics After Elective Colorectal Surgery: A Comparative Study.: Kim, Yoon Seok , Lee, Seung Hyun , Ahn, Byung Kwon , Baek, Sung Uhn; J Korean Soc Coloproctol. 2009;25(1):14-19.; DOI: https://doi.org/10.3393/jksc.2009.25.1.14

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Abstract PDF

PURPOSE
The use of prophylactic antibiotics is the current standard of care after elective colorectal surgery. The aim of this study was to compare the efficacy of antibiotic prophylaxis with dual antibiotic therapy and triple antibiotic therapy after elective colorectal surgery.
METHODS
We studied consecutive patients underwent elective colorectal surgery from January to June, 2007. Patients of triple-therapy group were administered second cephalosporin, metronidazole, and aminoglycoside for early 3 mo and dual-therapy group were administered second cephalosporin and metronidazole for next 3 mo. The prophylactic antibiotics were administered 2-3 doses for 24 hr after surgery. The surgery for diverticulitis, inflammatory bowel disease, and colon obstruction were excluded. Wound conditions were checked on alternate days during the hospital stay and follow up at least for 30 days after discharge.
RESULTS
Over 6 mo, 110 patients were enrolled (59 dual-therapy group, 51 triple-therapy group). In two group, sex, age, American Society of Anesthesiology score, body mass index, combined diseases, and location of disease were similar. Wound infection rate were 1.7% in dual-therapy group and 2.0% in triple-therapy group (P=1.0). Anastomotic leakage rate were 5.1% in dual-therapy group and 2.0% in triple-therapy group (P=0.622).
CONCLUSION
The addition of aminoglycoside to dual antibiotic therapy, second cephalosporin-metronidazole showed on advantage in prevention of postoperative wound complications. Further studies are required to establish appropriate guideline of antibiotic prophylaxis after elective colorectal surgery.

Citations

Citations to this article as recorded by

Overview of Antibiotic Use in Korea
Baek-Nam Kim
Infection & Chemotherapy.2012; 44(4): 250. CrossRef
A Prospective, Multicenter, Randomized Trial for Duration of the Prophylactic Antibiotics after Elective Colorectal Surgery: 3 Days versus 5 Days
Ji Won Park, Jae Hwan Oh, Hyo Seong Choi, Sang-Bum Yoo, Young-Ju Choe, Sohee Park, Jung Man Kim, Kang Young Lee, Seung Kook Sohn, Hae Ran Yun, Ho-Kyung Chun, Woo Yong Lee
Journal of the Korean Society of Coloproctology.2010; 26(2): 123. CrossRef
Antimicrobial Prophylaxis Using a 2nd Generation Cephalosporin after Laparoscopic Colorectal Resection: A Randomized Trial of 1-day vs. 3-day
Han Deok Kwak, Dong Jin Choi, Si Uk Woo, Jin Kim, Jun Won Um, Seon Hahn Kim
Journal of the Korean Surgical Society.2010; 78(6): 385. CrossRef
Association Between Prophylactic Antibiotic Use and Surgical Site Infection Based on Quality Assessment Data in Korea
Kyoung Hoon Kim, Choon Seon Park, Jin Hee Chang, Nam Soon Kim, Jin Seo Lee, Bo Ram Choi, Byung Ran Lee, Kyoo Duck Lee, Sun Min Kim, Seon A Yeom
Journal of Preventive Medicine and Public Health.2010; 43(3): 235. CrossRef

Evaluation of Anal Continence Function by Advanced Anal Manometric Parameters.: Seong, Moo Kyung , Kim, Keun Young , Yoo, Young Bum; J Korean Soc Coloproctol. 2009;25(1):20-25.; DOI: https://doi.org/10.3393/jksc.2009.25.1.20

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Abstract PDF

PURPOSE
Anal manometry is one of the most commonly used tests to evaluate fecal continence function. Advanced pressure parameters of the tests, such as fatigue rate index (FRI), resting rectoanal pressure gradient (RPG), cough index (CI), and radial asymmetry (RA) are recently devised to make up the inaccuracy of conventional parameters, but without solid verification. The object of this study is to investigate such parameters including conventional ones in incontinent patients compared with those in controls and to determine the significance of each parameter.
METHODS
Forty-four patients with anal incontinence and 42 controls were studied. We examined conventional pressure parameters (mean resting pressure [MRP], maximum squeeze pressure [MXSP]) and advanced parameters (RPG, FRI, CI, RA), and compare those parameters with normal controls. Multiple logistic regression analysis and receiver operating characteristic curve analyses were also performed.
RESULTS
No difference was detected in demographic factors between the two groups. Basic manometric parameters were significantly different between the two groups (MRP, 31.1+/-20.7 mmHg vs. 41.4+/-18.6 mmHg, P=0.0170; MXSP, 203.1+/-84.3 mmHg vs. 258.5+/-105.9 mmHg, P=0.0086). Among advanced parameters, RPG and FRI were significantly different (2.83+/-1.54 vs. 4.08+/-1.53, P=0.0003; 9+/-21.6 sec vs. 75.6+/-12.1 sec, P=0.0333), but CI and RA were not so different (0.74+/-0.45 vs. 0.61+/-0.33, P=0.1326; 22.7+/-7.0% vs. 21.1+/-7.6%, P=0.3244). Only RPG was significant in multiple logistic regression analysis (P=0.019). Areas under ROC curves were 0.65 for MRP, 0.65 for MXSP, 0.82 for RPG, and 0.73 for FRI.
CONCLUSION
Among anal manometric pressure parameters, RPG and FRI as advanced parameters are more accurate than any other parameters in detecting fecal incontinence.

Citations

Citations to this article as recorded by

Anorectal manometric parameters are influenced by gender and age in subjects with normal bowel function
Hyang Ran Lee, Seok-Byung Lim, Jeong Yun Park
International Journal of Colorectal Disease.2014; 29(11): 1393. CrossRef
Determinant of Anal Resting Pressure Gradient in Association With Continence Function
Moo-Kyung Seong, Ung-Chae Park, Sung-Il Jung
Journal of Neurogastroenterology and Motility.2011; 17(3): 300. CrossRef

The Expression and Clinical Correlations of Matrix Metalloproteinase-2, -7, -9, and -12 in Colorectal Cancer.: Ahn, Eun Jung , Chung, Soon Sup , Lee, Ryung Ah , Kim, Kwang Ho; J Korean Soc Coloproctol. 2009;25(1):26-33.; DOI: https://doi.org/10.3393/jksc.2009.25.1.26

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Abstract PDF

PURPOSE
Tumor invasion and metastasis are multistep phenomina, involving proteolytic degradation of extracellular matrix (ECM) and alteration of cell adhesion. It is another oncologic therapeutic strategy to block tumor invasion and metastasis through analyzing the molecules which are involved in these processes. We examined the expressions of some of matrix metalloproteinases (MMPs) in colorectal cancer and analyze the correlation with clinical factors and survival.
METHODS
Fifty-five patients with colorectal cancer who underwent surgical resection were included. The expressions of the MMP-2, -7, -9, and -12 in tumor tissue and normal mucosa using RT-PCR technique was carried out. We evaluated and analyzed the correlation among these molecules, clinical characteristics, and survival.
RESULTS
Expressions of MMP-7, -9, and -12 were significantly higher in tumor tissue than in normal mucosa (P=0.00). The expressions of MMP-2 between cancer and normal mucosa had no significant difference but it had a significant difference according to the lymph node (LN) invasion (P=0.03) in tumor tissues. Three-year overall survival was worse in patient with high expression of MMP-2 compared to low expression.
CONCLUSION
The expressions of MMP-7, -9, -12 in tumor tissue were higher than in normal mucosa and MMP-2 expression of tumor tissues had a significant difference according to LN invasion. MMP-2 overexpression seems to be a prognostic factor for 3-yr overall survival. But, large scale study with long term survival analysis will be needed for the prognostic significance of MMPs.

Citations

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Invasiveness of and Drug Sensitivity to Various Anti-cancer Regimens in Five Colorectal Cancer Cell Lines
Yoo Mi Lee, Yong Sik Yoon, Seon Ae Roh, Dong Hyung Cho, Jin Cheon Kim
Journal of the Korean Society of Coloproctology.2010; 26(2): 98. CrossRef

Treatment of Multiple Colorectal Cancers.: Paek, Ok Joo , Oh, Seung Yeop , Suh, Kwang Wook; J Korean Soc Coloproctol. 2009;25(1):34-40.; DOI: https://doi.org/10.3393/jksc.2009.25.1.34

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Abstract PDF: PURPOSE
The detection of synchronous and metachronous colon cancer is important for the surgical treatment. The aim of this study is to review the clinicopathological characteristics of multiple colon cancers.
METHODS
A retrospective analysis was performed with 43 patients with multiple colon cancers who underwent surgical treatment from June 1996 to May 2008. Patients with familial adenomatous polyposis and cancer from inflammatory bowel disease were excluded.
RESULTS
There were 43 cases of multiple colon cancers. Synchronous colon cancers were present in 30 patients and metachronous colon cancers were present in 18 patients. The mean age was 61.33+/-11.44, and the male-to-female ratio was 23:20. The index cancer and the second cancers in synchronous colon cancers, as well as the first colon cancer in metachronous colon cancers showed, significantly more distal tumor locations. However, the second cancers in metachronous colon cancers showed no significant differences in tumor location. As for stage, a more advanced stage was noted in the index cancer than in the second cancers in synchronous cancer. However, an early stage was noted for the first colon cancer in metachronous cancers. Seventeen patients with synchronous cancer and 14 patients with metachronous colon cancer underwent a total or a subtotal colectomy.
CONCLUSION
Detection of synchronous colon cancer was important for deciding the extent of surgical resection. Patients with colon cancer should be considered for frequent colonoscopy follow-up for early detection of metachronous colon cancer.

Short-term Oncologic Outcome of Curative Resection for Obstructive Colorectal Cancer Followed by Stent Insertion: Comparative Study with Non-abstructive Colorectal Cancer.: Chang, Yeon Soo , Kim, Seong Rae , Choi, Sung Il , Joo, Sun Hyung , Lee, Suk Hwan; J Korean Soc Coloproctol. 2009;25(1):41-45.; DOI: https://doi.org/10.3393/jksc.2009.25.1.41

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Abstract PDF

PURPOSE
Recently, a self-expandable metallic stent has allowed an elective single-stage resection avoiding the risk of emergency operation and stoma formation in patients with obstructive colorectal cancer (CRC). But, forceful expansion of stent may increase the possibility of tumor cell exfoliation and dissemination through bowel lumen, lymphatic and blood vessels. Aim of study is to evaluate the short-term outcome of curative resection for obstructive colorectal cancer followed by stent in terms of oncologic safety.
METHODS
Twenty-seven patients who underwent curative resection for obstructive CRC followed by stent insertion were included in 'stent group' and control group included 87 patients who underwent surgery for non-obstructive CRC. The clinicopathologic characteristics and prognosis were compared between two groups.
RESULTS
There was no significant difference in clinicopathologic characteristics between two groups. No difference was found in postoperative complications between two groups. Overall survival rate of two groups showed no statistically significant differences (P=0.1254). Stage-matched survival rates (stage II & III) were also showed no differences between two groups.
CONCLUSION
Stent insertion itself does not compromise the survival of patients with obstructive CRC. Oncologic safety of stent insertion for obstructive CRC is acceptable. A further large-scaled prospective study and long-term follow-up is necessary to evaluate the oncologic safety of stent insertion in obstructive CRC.

Citations

Citations to this article as recorded by

Comparison of short-term outcomes after elective surgery following endoscopic stent insertion and emergency surgery for obstructive colorectal cancer
Gil Jae Lee, Hyo Jun Kim, Jeong-Heum Baek, Won-Suk Lee, Kwang An Kwon
International Journal of Surgery.2013; 11(6): 442. CrossRef
Short-Term Outcome of Curative One-Stage Laparoscopic Resection for Obstructive Left-Sided Colon Cancers Followed by Stent Insertion: Comparative Study with Non-Obstructive Left-Sided Colon Cancers
Hyun Sil Kim, Sung Geun Kim, Chang Hyuk Ahn, Won Kyung Kang, Yun Seok Lee, In Kyu Lee, Hyung-Jin Kim, Sang Cheol Lee, Hyeon Min Cho, Jong Kyung Park, Seong Taek Oh, Jun-Gi Kim
Journal of the Korean Society of Coloproctology.2009; 25(6): 417. CrossRef

Neuroendocrine Carcinoma of the Colon and Rectum.: Kim, Dong Hun , Lee, Woo Yong , Yun, Hae Ran , Choi, Young Cheol , Cho, Yong Beom , Yun, Seong Hyeon , Kim, Hee Chol , Chun, Ho Kyung; J Korean Soc Coloproctol. 2009;25(1):46-51.; DOI: https://doi.org/10.3393/jksc.2009.25.1.46

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Abstract PDF

PURPOSE
The aim of this study was to review our experience with neuroendocrine carcinoma (NEC) of the colon and rectum to highlight the clinical and pathological characteristics in this relatively uncommon malignancy.
METHODS
From December 1995 to December 2006, 11 patients with NEC were identified from our database of 6,143 colorectal cancer patients (0.18%), which does not include carcinoid tumors. The pathology was retrospectively reviewed and the tumors were categorized as pure NEC, including well-differentiated NEC (n=3), poorly-differentiated (n=3) and mixed endocrine/exocrine tumor (n=5) on the basis of the histology and immunohistochemical findings.
RESULTS
The mean age of the patients was 57 yr (range, 37 to 69 yr). The tumors were located as follows: 8 in the colon and 3 in the rectum. The diagnosis of NEC was suggested preoperatively from the tissue biopsy in 2 of 9 patients (22.2%). The tumors were advanced at the time of diagnosis, with American Joint Committee on Cancer Stage III (n=7) and Stage IV disease (n=4). Most tumors stained positive by immunohistochemistry for neuroendocrine markers, including synaptophysin (7/9, 77.8%); however, chromogranin was expressed in 4 of 9 NEC tumors (44.4%). Metastatic disease was detected at the time of diagnosis in 36.4% (4/11) of the patients. The median survival for NEC was 16 mo (3.6-67.4 mo), and for pure NEC and mixed endocrine/exocrine tumor was 4.1 mo and 23.6 mo, respectively.
CONCLUSION
NEC had distinctive cytoarchitectural features and was often immunoreactive for neuroendocrine markers. Our findings showed that pure NEC had aggressive behavior and a poor prognosis.

Citations

Citations to this article as recorded by

Small-cell neuroendocrine carcinoma of the rectum — a rare tumor type with poor prognosis: A case report and review of literature
Zhen-Zhou Chen, Wang Huang, Zheng-Qiang Wei
World Journal of Clinical Cases.2020; 8(23): 6095. CrossRef
Small-cell neuroendocrine carcinoma of the rectum - a rare tumor type with poor prognosis: A case report and review of literature
Zhen-Zhou Chen, Wang Huang, Zheng-Qiang Wei
World Journal of Clinical Cases.2020; 8(23): 6089. CrossRef
Four Cases of Carcinoid Tumor in Asymptomatic Thirties
Seung Hwa Lee, Won Ae Lee, Eal Whan Park, Yoo Seock Cheong
Korean Journal of Family Medicine.2011; 32(2): 135. CrossRef

Case Reports

Rectal Involvement of Klippel-Trenaunay Syndrome.: Cheon, Seong Hui , Lee, Suk Hwan , Park, Eung Bum; J Korean Soc Coloproctol. 2009;25(1):52-55.; DOI: https://doi.org/10.3393/jksc.2009.25.1.52

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Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder and is essentially a disorder of capillary, venous, and lymphatic malformations. Hematochezia is the most common symptom associated with intestinal hemangiomatosis and remains one of the life-threatening emergencies in KTS. We reported one patient of KTS presented with rectal bleeding and severe anemia who was successfully managed by sphincter-saving operation.

Citations

Citations to this article as recorded by

A case report of multiple renal aneurysms due to Klippel-Trenaunay syndrome requiring laparoscopic nephrectomy
Mayur Gami, Syed Rahman, Gerald Rix, Adam Howard, Sam Datta
International Journal of Surgery Case Reports.2023; 106: 108070. CrossRef
Rectal and Splenic Vascular Malformation in Klippel-Trenaunay-Weber Syndrome: A Case Report
Ha Youn Kim, Yun Woo Chang, Dong Hwan Lee
Journal of the Korean Society of Radiology.2012; 67(4): 289. CrossRef

Intestinal Obstruction Aggravated by Colonoscopy: A Case Report.: Kim, Hae Jung , Lee, In Tak , Yok, Eu Gon , Lee, So Jin , Lee, Suk Hee , Kim, Do Sun , Lee, Du Han; J Korean Soc Coloproctol. 2009;25(1):56-58.; DOI: https://doi.org/10.3393/jksc.2009.25.1.56

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Abstract PDF

Colonoscopy is a frequently performed procedure used for colorectal cancer screening. Most frequent complication is colonic perforation and bleeding. Other visceral injuries are very rare, but injuries to the spleen and liver have been described. We report on 66-yr-old female who presented with abdominal pain after uneventful colonoscopy. Abdominal CT scan revealed a band at previous hysterectomy site and dilated small bowel suggesting strangulated loop. A broad based knowledge of the different complication is necessary to decrease the risk of associated morbidity and mortality.

Citations

Citations to this article as recorded by

Severe ileus after colonoscopy in a patient on peritoneal dialysis
Sang Un Kim, Su Hee Kim, So Yoon Hwang, Ryang Hi Kim, Ji Young Choi, Jang Hee Cho, Chan Duck Kim, Yong Lim Kim, Sun Hee Park
Yeungnam University Journal of Medicine.2017; 34(1): 119. CrossRef

Original Article

A Case of Single Port Laparoscopic Appendectomy and Cholecystectomy in a Fresh Cadaver: A Feasible Procedure.: Kim, Hyung Jin , Lee, Jae Im , Lee, Yoon Suk , Kang, Won Kyung , Lee, Sang Kuon , You, Young Kyung , Oh, Seong Taek; J Korean Soc Coloproctol. 2009;25(1):59-62.; DOI: https://doi.org/10.3393/jksc.2009.25.1.59

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Abstract PDF

We performed single port transumbilical appendectomy and cholecystectomy using the TriPort (R-port, Advanced Surgical Concepts, Wicklow, Ireland), inserted through a transumbilical incision in a cadaver model. A articulating instrument, Autonomy(TM) (Cambridge Endo, MA, USA) in right hand was used for retraction in addition to a standard laparoscopic instrument in left hand for dissection and coagulation. Both procedures were technically successful. In conclusion, single port surgery may be performed safely. And in the near future, more complex procedures could be performed through single port in accordance with the advancement of the instruments.

Citations

Citations to this article as recorded by

Bending Mechanism Analysis and Bending Coupler Optimal Design for Laparoscopic Surgical Instrument
Dal Yeon Hwang, Dae Hoan Moon, Seung Wook Choi, Jong Seok Won
Journal of the Korean Society of Precision Engineering.2013; 30(4): 434. CrossRef
Single-port transumbilical laparoscopic appendectomy: 43 consecutive cases
Hyung Jin Kim, Jae Im Lee, Yoon Suk Lee, In Kyu Lee, Jung Hyun Park, Sang Kuon Lee, Won Kyung Kang, Hyeon-Min Cho, Young Kyuong You, Seong Taek Oh
Surgical Endoscopy.2010; 24(11): 2765. CrossRef
Single port laparoscopic surgery
Woo-Jung Lee
Journal of the Korean Medical Association.2010; 53(9): 793. CrossRef
Single-Port Laparoscopic Appendectomy
Hyung Jin Kim, Jae Im Lee, Sang Chul Lee, Soo Hong Kim, In Kyu Lee, Yoon Suk Lee, Hyeon-Min Cho, Seong Taek Oh
Journal of the Korean Surgical Society.2010; 78(5): 338. CrossRef

Review

Liver Metastases in Colorectal Cancer.: Lee, Jae Im , Oh, Seong Taek; J Korean Soc Coloproctol. 2009;25(1):63-72.; DOI: https://doi.org/10.3393/jksc.2009.25.1.63

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Abstract PDF: Liver metastases in colorectal cancer are a frequent and lethal complication. Although hepatic resection is an effective treatment for patients with liver metastases in colorectal cancer, only 10-20% of the patients with liver metastases in colorectal cancer are indicated on hepatic resection. However, over the past several decades, liver resection has evolved as a safe and potentially curative treatment for liver metastases in colorectal cancer. Currently the absolute number of patients amenable to resection is large and is growing with better imaging, better surgery, and improvements in systemic therapies to reduce the risk of both intrahepatic and extrahepatic recurrences. The development of active chemotherapy and molecular targeted therapies, together with newer modalities like radiofrequency ablation, have expanded the indications for hepatic resection and improved survival. Also, although initially unresectable, a hepatic resection of colorectal liver metastases after down-sizing by using the above mentioned treatment modalities and chemotherapy can provide a hope for long-term survival that is similar to that of primarily resectable patients. To achieve this objective, for patients with liver metastases, a multidisciplinary team approach has become mandatory, with routine re-evaluation of patients and with adequate timing for each treatment.

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