Manejo atual das metástases hepáticas de câncer colorretal: recomendações do Clube do Fígado de São Paulo

Abstract

Approximately half of patients with colorectal cancer present with liver metastases during the course of their disease, which directly affect prognosis and is responsible for two thirds of deaths related to the disease. In the last two decades the treatment of liver metastases from colorectal cancer (CRCLM) provided significant gain in survival when all treatment options are available to the patient. In this context, surgical treatment remains as the only chance of cure, with five-year survival rates of 25-58%. However, only 1/4 of the patients have resectable disease at diagnosis. For this reason, one of the key points in the current management of patients with CRCLM is the development of strategies that facilitate complete resection of liver lesions. The advent and refinement of ablative methods have expanded the possibilities of surgical therapy. The emergence of new chemotherapy regimens and the introduction of targeted therapies has provided high response rates and has permanently altered the management of these patients. The multimodal therapy and the involvement of different medical specialties has increasingly enabled CRCLM treatment to approached the ideal treatment, i.e., an individualized one. Based on an extensive review of literature and on experience from some of the most important specialized centers of Brazil, the São Paulo Liver Club began a process of multi-institutional discussions that resulted in the recommendations that follow. These recommendations, however, are not intended to be absolute, but useful tools in the therapeutic decision process for this complex group of patients.

Surgical Outcomes and Prognostic Factors in Patients With Synchronous Colorectal Liver Metastases

“…Therapeutic benefits from colorectal cancer liver metastases resection have been reported since the early 1990s, with 5-year survival rates ranging from 25% to 58% (22,29) . Large case series have reported substantial increases in survival among patients undergoing resection as compared with patients in whom resection was not possible or patients with resectable disease in which surgery was withheld for some reason (35) .…”

“…Large case series have reported substantial increases in survival among patients undergoing resection as compared with patients in whom resection was not possible or patients with resectable disease in which surgery was withheld for some reason (35) . The current criteria for surgical treatment of CLM are resection of all metastases with clear margins and ability to preserve at least 25% future liver remnant with good perfusion and adequate venous drainage (12,22) . The main contraindications to resection are presence of unresectable extrahepatic disease and impossibility of complete resection of all liver lesions (11) carcinoembryonic antigen.…”

“…In the majority of studies, synchronous metastases -detected simultaneously with the primary tumor or within 1 year of primary tumor resection -account for 25% to 50% of cases of colorectal liver metastases (CLM), whereas metachronous progression occurs in approximately 60% of patients (16) . Surgical resection of CLM provides the sole possibility of cure and the best odds of long-term survival (16,22,42) . Patients submitted to resection can achieve 5-year survival rates of up to 57% after resection with low rates of perioperative morbidity and mortality, which has made resection the treatment of choice (22,23,25,44) .…”

“…Surgical resection of CLM provides the sole possibility of cure and the best odds of long-term survival (16,22,42) . Patients submitted to resection can achieve 5-year survival rates of up to 57% after resection with low rates of perioperative morbidity and mortality, which has made resection the treatment of choice (22,23,25,44) . Several prognostic factors of long-term survival have been studied in attempt to select patients who will benefit from resection of liver metastases and to propose novel therapies for those at high risk of disease recurrence (33) .…”

Importância Da Vacinação Contra O Vírus HPV E Sua Relação Com O Câncer Do Colo Do Útero

“…O sítio de acometimento mais comum é o fígado, com estimativa de até 80% dos casos, porém, apenas 15% a 30% são favoráveis à cirurgia de ressecção(CHEDID et. al, 2003;LUPINACCI et. al, 2013).…”