Surgical and Multimodality Treatment of Colorectal Liver Metastases

Abstract

For patients with colorectal liver metastases, surgery offers the only possibility for cure. The achievable mean 5-year survival rate is 30%, and the 5-year disease-free survival rate approximately 15%. Due to refinement in operative and anesthetic techniques, improved critical care with a decrease in morbidity (< 30%) and mortality (< 5%), hepatic resection is a safe and efficient procedure. However, only 10–15% of patients with colorectal liver metastases can undergo potentially curative liver resection. Therefore, accurate staging is an important prerequisite in selecting patients who would benefit from surgery. Today, the most generally accepted contraindication for liver resection is the presence of discontinuous extra-hepatic spread and more than 4 metastases. Recurrence of hepatic metastases after potentially curative resection is observed in over 50% of cases. Re-resection of recurrent liver metastases can be beneficial in a carefully selected group of patients with limited disease. Multimodal neoadjuvant therapy is a promising tool for patients with colorectal liver metastases initially considered not R0-resectable. Cryosurgery and laser-induced thermotherapy are additive methods that may help to improve surgical treatment results in the future. Improvement in clinical outcome and survival can be achieved.

Effects of acetylsalicylic acid and acetic acid solutions on VX2 liver carcinoma in rabbits: in vivo analysis

“…Surgical resection is the main treatment for neoplasia and is the only one that offers the possibility of a cure. However, only small percentages (10 -15%) of patients are good candidates for surgical intervention 3 . Among the palliative methods, ablation stands out.…”

Effects of phenol, glycerin and acetic acid on the liver of guinea pigs

“…During surgical procedures, surgeons frequently face limited possibilities of therapeutic action due to the infeasibility of neoplastic tissue total resection, such as when various visceral metastases, and hepatic metastases in particular, exist 1,2 . The major therapeutic modalitites presently used in the treatment of hepatic metastases are: surgical resection, artery ligation, embolization and chemotherapy, ablation methods (laser, radiofrequency, cryotherapy, hyperthermia, microwaves, and necrotizing and cytolytic substances) and genetic therapy 3,4 .…”

“…To this date, surgical resection, the major therapeutic modality, is the only procedure that may result in cure. Nevertheless the number of patients capable of undergoing surgery (10 -15%) is low 2 . Among palliative methods, the ablative approach is distinguished as it uses cytolytic and necrotizing substances such as alcohol or other methods, namely, cryotherapy, radiofrequency, laser and microwaves for localized lesion destruction.…”

Effects of acetylsalicylic acid and acetic acid solutions in VX2 carcinoma cells: In vitro analysis

“…Surgical resection is the main treatment for neoplasia and is the only one that offers the possibility of a cure. However, only small percentages (10 -15%) of patients are good candidates for surgical intervention 3 .…”