New Strategies to Enhance the Efficacy of Surgical Treatment for Colorectal Liver Metastasis

Abstract

Additional information is available at the end of the chapter http://dx.doi.org/10.5772/57326 . IntroductionColorectal cancer CRC is the second most common cause of cancer death worldwide [ ]. The liver is the most frequent site of metastasis in CRC, both at the time of diagnosis -% of cases and after apparently radical surgery on the primary tumour nearly % of cases . If patients with colorectal liver metastasis CRC-LM are not treated, prognosis is very poor, with a near zero five-year survival rate. "t present, liver resection is the only treatment modality that has the potential to achieve long-term survival and to offer the possibility of a cure. Patients who undergo complete R resection of liver metastases have a five-year survival rate of approximately -% [ ]. Unfortunately, however, % to % of patients develop secondary metastatic disease after R -resection of CRC-LM [ ].In order to obtain the best results in a systemic disease such as metastatic CRC mCRC , the optimal integration of medical treatment and surgery is essential. The introduction of several effective cytotoxic and targeting agents, in combination with surgical treatment, has extended survival [ ]. In addition, promising emerging therapies -cancer stem cell CSC -targeted therapies, pathway inhibitors for CRC, induction of tumour cell differentiation, improving liver regeneration, and nanoparticle NP -guided tumour ablation, among others-may be found to be effective in achieving better control and even complete eradication of CRC-LM. If confirmed, these strategies will bring significant benefits to patients, particularly in terms of long-term survival. Further, in this era of multimodality treatment of CRC, it is critically important to identify effective biomarkers for prognosis and prediction of individual treatment responses, and these are expected to become useful tools for improving therapeutic approaches.© 2014 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.The present chapter aims i, to present the state of the art related to criteria for appropriate decision making for CRC-LM treatment ii, to review the current data on the role of biomarkers used for the prediction of response to CRC-LM therapies and iii, to outline emerging targeting agents and new therapeutic techniques to improve life expectancy and quality of life in CRC-LM patients.. Therapeutic approaches to colorectal liver metastases: The state of the art More than half of patients with CRC will develop liver metastases, and nearly % of them are initially unresectable. Hence, optimal management of hepatic metastases often requires a multidisciplinary approach. The availability of new medical therapies, including neoadjuvant chemotherapy and targeted therapies, render a considerable percentage up to % of initially unresectable patients potent...