Hepatic Surgery for Colorectal Cancer Metastasis — Possibilities and Prerequisites

Abstract

Colorectal cancer is among the most frequent malignant tumours. Liver metastases develop in % of patients affected by colorectal carcinoma. Nowadays, surgical treatment can significantly improve the -year survival ranging % of the patients undergoing liver surgery. The operation extent ranges from nonanatomic minor resection to major hepatectomy. Recently, liver transplantation has been performed for metastatic colorectal cancer. Laparoscopic approach and robotic surgery can be used by experienced specialists. The prerequisites for successful surgical treatment include exact radiologic diagnostics to determine the number and size of metastases and their association with anatomic structures individual anatomic peculiarities and remnant liver volume, ranging % in respect to functional liver status. Magnetic resonance imaging is the most sensitive method that has marked advantages in the diagnostics of lesions smaller than cm and metastases on the background of liver steatosis. Computed tomography is an acceptable alternative that benefits from high spatial resolution and optimal reconstructions to evaluate the anatomy. Additional information can be obtained from tumour markers, including traditional, e.g., carcinoembryonic antigen CEA and novel, e.g., microRNAs. To ensure that each colorectal cancer patient receives the best care, the medical society should be well informed about the possibilities in the treatment of liver metastases of colorectal cancer regarding the methods, indications and limits.Keywords: Colorectal cancer, liver metastasis, liver resection, magnetic resonance imaging © 2015 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. . IntroductionColorectal cancer CRC represents one of the leading malignant tumours both by incidence and death rate [ , ]. Metastatic spread to liver occurs in % of patients, and % of CRC patients present with synchronous liver metastases [ , , ]. Although the presence of metastatic disease significantly adversely affects the survival, a wide scope of treatment options exists. To ensure that each colorectal cancer patient receives the best care, the medical society should be well informed about the possibilities in the treatment of liver metastases of colorectal cancer regarding the methods, indications and limits.Surgery is the preferred option for long term survival. The operation extent ranges from major hepatic resection trisegmentectomy, hepatectomy, extended hepatectomy, and hemihepatectomy to parenchyma-sparing minor resection such as segmentectomy or wedge resection [ ]. Laparoscopic approach and robotic surgery can be considered, especially in advanced centres [ , ]. In patients with questionable adequacy of the liver remnant and wide intrahepatic tumour spread, portal vein occlusion, forced liver hypertrophy and staged ...

Diagnostic Algorithm of Hepatocellular Carcinoma: Classics and Innovations in Radiology and Pathology

“…The hepatobiliary phase of MRI corresponds to the peak parenchymal enhancement due to contrast uptake in hepatocytes. Depending on the agent, the hepatobiliary phase develops either 10-20 (gadoxetate) or 60 (gadobenate dimeglumine) minutes after injection [42]. Most of HCCs are hypointense in hepatobiliary phase [18].…”