Management of colorectal liver metastases

Abstract

Hepatic metastases occur in 60% of patients following resection for colorectal cancer. Liver resection is the only curative option, with one third of resected patients alive at five years. In those developing recurrence in the liver following resection, further liver surgery may be curative, with similar 5 years survival rates of about 30%. Until recently surgery was feasible in only 15-25% of patients with colorectal liver metastases. New strategies, such as downstaging chemotherapy, portal vein embolization and two-stage hepatectomy, may increase the resectability rate by 15%. Earlier detection of liver metastases would increase resectability, although good follow-up trials are lacking. Once suspected, colorectal liver metastases are staged by spiral CT, CT portography and MRI, which have similar overall accuracies. Mortality following liver resection is less than 5% in major centres, with a morbidity rate of 20% to 50%. Prognostic scoring systems can be used to predict the likely cure rate with resection. Pulmonary metastases occur in 10-25% of patients with resected colorectal cancer, but are limited to the lung in only 2% of cases. In these selected cases surgery provides long-term survival in 20-40%, and repeat lung resection has shown similar rates. For patients with unresectable disease, chemotherapy and ablation techniques have been demonstrated to prolong survival, although chemotherapy alone has been shown to improve quality of life.

Distinct Functionality of Tumor Cell–Derived Gelatinases during Formation of Liver Metastases

“…These findings provided initial support for the notion that MMP-9 might be more involved in metastasis and should therefore be targeted, because the number of metastases is an important determinant of survival of cancer patients. Patients can survive with few growing metastases, whereas great numbers of liver metastases are often clinically not manageable (46,47).…”

Current Surgical Management of Colorectal Cancer Liver Metastases: A Mini Review

“…The patients should be followed-up every 3 -6 months for the first 3 years and once every year thereafter. It is recommended that tumor marker CEA should be monitored in a very defined population, especially when elevated levels are found preoperatively and could be valuable in early recognition of metastases [1].…”

“…FDG-PET can provide a helpful adjunct to CT in detecting extrahepatic metastases and also in making classic staging more accurate. Nevertheless, it does not seem to provide further information for the determination of the extent of metastatic disease in the liver parenchyma [1]. It has been reported that FDG-PET added further diagnostic value by 38% reduction in futile laparotomies [11].…”

“…Current treatment strategies such as down-staging chemotherapy, portal vein embolization and two-stage resections can be applied in cases of extensive metastases and result in further increasing the resectability rate by 15% [1,16,17]. The aim of down-staging chemotherapy is to reduce the size of the metastases as much as possible before resection.…”

“…60% of colorectal cancer patients will develop metastatic disease, half of which will be located in the liver. While the lung is the most common extra-abdominal metastatic site, other less frequent metastatic locations such as the brain, bones, ovaries, penis and adrenal glands have been reported [1][2][3]. A multidisciplinary approach using of all modalities improves the short and long-term outcome [4][5][6][7].…”