Management of potentially resectable colorectal cancer liver metastases

Abstract

Colorectal cancer is a very common malignancy worldwide and development of liver metastases, both synchronous or metachronous, is a common event. Of all patients with metastatic colorectal cancer, up to 77% have a liver-only disease and approximately 10%-20% of patients with colorectal liver metastases are considered resectable at the time of diagnosis. Surgical resection of liver metastases remains the best treatment option and it is associated with a survival plateau and a 20%-25% of long-term survivors. Perioperative chemotherapy for resectable liver metastases may improve resecability of liver metastases and disease free survival, but its impact on overall survival is still unclear and more studies are needed. Moreover, preoperative chemotherapy can increase postoperative complications. Further studies are needed to define the role of adjuvant chemotherapy after a R0 resection of liver metastases and to define the criteria for a better selection of patients candidate to hepatectomy. New strategies such as targeted therapies are emerging with promising results. Optimal management requires a multidisciplinary approach, local and systemic, but it is a still pending question. Colorectal liver metastases represent a major challenge for oncologists and surgeons. In this review will be analyzed available data about assessment and management of the patients with potentially resectable colorectal liver metastases.© 2013 Baishideng. All rights reserved. Key words: Colorectal cancer; Liver metastases; Perioperative chemotherapy; Surgical resection; Targeted therapiesCore tip: Colorectal cancer is a very common malignancy and its incidence is rapidly increasing worldwide. Of all patients with metastatic colorectal cancer, up to 77% have a liver-only disease and about 10%-20% of them are considered resectable at the time of diagnosis. Surgery actually still represents the best option of treatment, but new strategies such as perioperative chemotherapy and targeted therapies are emerging with promising results. However, optimal management requires a multidisciplinary approach, both local and systemic. This review aims to critically analyze the management of potentially resectable colorectal liver metastases.Meriggi F, Bertocchi P, Zaniboni A. Management of potentially resectable colorectal cancer liver metastases. World J Gastrointest Surg 2013; 5(5): 138-145 Available from:

Role of imaging for patients with colorectal hepatic metastases: what the radiologist needs to know

“…Restrictive criteria for eligibility of resection were introduced in the late 1980s and were as follows: four or fewer metastatic lesions, maximum tumor diameter less than 5 cm, the absence of extrahepatic disease, and a negative surgical margin of at least 1 cm ( Fig. 1) [10,11]. However, all of these criteria have been challenged over the past decade as they were derived from antiquated studies and the definition of resectability has been modified [7].…”

Abstracts of the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland

“…67 patients went on to have a laparotomy with a view to resection surgery. 22 patients (28·2%) were found to be inoperable at laparotomy; reasons for unresectability included unstable patient during anaesthetic (1), liver metastases (5), locally inoperable (13) and extensive nodal disease (3). Conclusion: Simple staging laparoscopy is still useful in detecting occult metastatic disease despite modern cross sectional imaging, prior to proceeding to laparotomy for radical resection surgery.…”

Predicting complications in hepatic resection for colorectal liver metastasis: the lymphocyte‐to‐monocyte ratio

“…1 The incidence varies globally, with the highest rates in Europe, North America and Australasia, with significantly lower rates in Africa and South Asia. [4][5][6][7] The main determinants of resectability are tumour size, location, multifocality and hepatic reserve. 2,3 With metastasectomy, up to 50% of patients with colorectal liver metastases (CLM) can achieve long-term survival, and as opposed to the turn of the century, an increasing number of cases are deemed resectable due to advances in surgical technique.…”

“…2,3 With metastasectomy, up to 50% of patients with colorectal liver metastases (CLM) can achieve long-term survival, and as opposed to the turn of the century, an increasing number of cases are deemed resectable due to advances in surgical technique. [4][5][6][7] The main determinants of resectability are tumour size, location, multifocality and hepatic reserve. The literature suggests that 5-year survival is approximately 40% after hepatic resection, and peri-operative mortality is generally less than 5%.…”