Use this URL to cite or link to this record in EThOS: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.724094
Title: Optimising the management of patients with synchronous colorectal liver metastases
Author: Slesser, Alistair Angus Peyre
ISNI:       0000 0004 6423 0753
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2014
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Abstract:
This thesis set out to determine whether the care of patients with synchronous colorectal liver metastases could be optimised. The evidence comparing the standard ‘sequential’ resection to simultaneous resections for patients with synchronous colorectal liver metastases was demonstrated to be prejudiced due to differing selection criteria between the two modalities. A comparative study demonstrated that simultaneous resections do result in equivalent short-term and long-term outcomes as sequential resections when comparing similar metastatic disease burdens. Whilst confirming that simultaneous resections can optimise the care of patients by reducing the length of hospital stay. The reported biological evidence suggested that synchronous colorectal liver metastases differ from metachronous colorectal liver metastases. There was insufficient evidence to determine whether those differences existed between the primary tumours of the two groups of patients. A radiological study comparing the primary tumour characteristics of the two groups suggested that the primary tumours of patients with synchronous colorectal liver metastases were more often locally advanced. In addition, the association of extra-mural venous invasion with the presence of synchronous disease was confirmed. A study investigating the timing of a primary tumour resection on the progression of synchronous colorectal liver metastases demonstrated that a delay in the provision of systemic chemotherapy resulted in progressive metastatic disease. The results generated from this thesis have been derived from exploratory studies and thus limits their full translation to clinical practice. However, the findings of this thesis support the use of simultaneous resections in selected patients with synchronous colorectal liver metastases. In addition, the results of this thesis suggest that the primary tumours of patients with synchronous and metachronous colorectal liver metastases do differ. The presence of extra-mural venous invasion should raise the suspicion of the presence or development of synchronous colorectal liver metastases during staging and post-operative surveillance.
Supervisor: Brown, Gina ; Tekkis, Paris P. ; Goldin, Robert ; Mudan, Satvinder Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.724094  DOI: Not available
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