Surgical Management of Colorectal Liver Metastases

Abstract

Colorectal cancer is the third most commonly diagnosed cancer with approximately half of the patients developing liver metastases during the course of their disease. Modern multimodal therapies have improved the overall survival. Liver resection remains the most important modality in the treatment of colorectal liver metastases. The evolution of the criteria for resectability has resulted in more patients being offered a hepatectomy. This is further augmented with the utilization of adjuncts to liver resection, including portal vein embolization and local ablative techniques. Two-stage hepatectomy is also being used to increase resectability. Overall survival is improved by the deployment of new chemotherapeutic agents and the use of combination chemotherapy. Neoadjuvant chemotherapy is a promising development in the treatment of colorectal liver metastases. Patients with colorectal liver metastases can achieve long-term survival. A multidisciplinary approach is essential in the management of these patients.KEYWORDS: Liver, colorectal liver metastases, hepatectomy, chemotherapyObjectives: On completion of this article the reader should be able to summarize the surgical management of colorectal liver metastases.Colorectal cancer is the third most commonly diagnosed cancer. There are one million new cases of colorectal cancer annually in both males and females worldwide.1 Approximately 50% of patients diagnosed with colorectal cancer will develop liver metastases over the course of their disease. 2 OUTCOMESThe natural history of untreated colorectal liver metastases is well documented. Outcomes for untreated disease are dismal. The median survival is in the order of 6 to 9 months. The 5-year survival ranges between 0 to 3%. [3][4][5] Outcomes are improved with resection. Surgery alone does offer a cure in a subset of patients. 6 The use of chemotherapy as an adjunct to liver resection has resulted in a 5-year survival in the range of 37 to 58%. [7][8][9] Ten-year survival is reported to be between 16 to 30%. 8,10,11 PROGNOSTIC FACTORS AND CLINICAL RISK SCORES Several prognostic factors have been reported to be associated with worse outcomes. Extrahepatic disease, extrahepatic lymph node involvement, satellite configuration of multiple metastases and initial detection of abnormal liver enzymes were originally reported to be

Anatomical versus nonanatomical resection of colorectal liver metastases: a meta-analysis

“…Patients with colorectal liver metastases (CLM) have a dismal prognosis. The median survival ranges from 6 to 9 months, and the 5-year survival is between 0% and 3% [2]. Hepatic resection is the only chance of cure for patients with CLM, and the 5-year survival rate after radical resection is about 37-58% [2].…”

MRI with Gadoxetate Disodium for Colorectal Liver Metastasis: Is It the New “Imaging Modality of Choice”?

“…1 Approximately 50 % of patients with colorectal cancer present with liver metastases at the time of diagnosis or as a result of recurrent disease. 1 Liver resection remains the gold standard for those patients that are deemed possible surgical candidates; this offers the best chance of a cure. 1 Imaging plays a key role in patient evaluation and in preoperative selection, for those patients that may be candidates for liver surgery.…”

“…1 Liver resection remains the gold standard for those patients that are deemed possible surgical candidates; this offers the best chance of a cure. 1 Imaging plays a key role in patient evaluation and in preoperative selection, for those patients that may be candidates for liver surgery. The modalities currently available for preoperative assessment include ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), 18-fluorodeoxyglucose positron emission tomography (FDG PET), and integrated PET-CT. 1 CT scan of the chest, abdomen and pelvis is most commonly used for staging colorectal cancer, especially for assessment of liver metastases.…”

“…1 Imaging plays a key role in patient evaluation and in preoperative selection, for those patients that may be candidates for liver surgery. The modalities currently available for preoperative assessment include ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), 18-fluorodeoxyglucose positron emission tomography (FDG PET), and integrated PET-CT. 1 CT scan of the chest, abdomen and pelvis is most commonly used for staging colorectal cancer, especially for assessment of liver metastases. Enhanced CT scan has a 69 to 71 % sensitivity and 86 to 91 % specificity, and MRI has a 81 to 86 % sensitivity and 93 % specificity for detecting liver metastasis.…”

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

“…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].…”