Review article

Current surgical treatment for colorectal liver metastases

Goran Mušterić ; Department of Surgical Oncology; University Hospital for Tumors; Sestre milosrdnice University Hospital Center; Zagreb; Croatia
Danko Velimir Vrdoljak ; Department of Surgical Oncology; University Hospital for Tumors; Sestre milosrdnice University Hospital Center; Zagreb; Croatia
Miroslav Lesar ; Department of Surgical Oncology; University Hospital for Tumors; Sestre milosrdnice University Hospital Center; Zagreb; Croatia
Ivan Penavić ; Department of Surgical Oncology; University Hospital for Tumors; Sestre milosrdnice University Hospital Center; Zagreb; Croatia
Iva Kirac ; Department of Surgical Oncology; University Hospital for Tumors; Sestre milosrdnice University Hospital Center; Zagreb; Croatia
Gordan Tometić ; Department of Surgical Oncology; University Hospital for Tumors; Sestre milosrdnice University Hospital Center; Zagreb; Croatia

Abstract

Approximately 50% of patients with colorectal cancer (CRC) will developduring their lifespan. Majority of colorectal liver metastases (CLM) patients will be unresectable at the time of diagnosis due to extensive intrahepatic and/or extrahepatic disease. R0 liver resection is still the only available treatment that allows long-term survival. In last two decades, the 5-year overall survival (OS) after curative liver resection of CLM has increased up to 58%. These improved outcomes are mainly due to multidisciplinary treatment of these patients. The definition of resectability has changed, so nowdays, the goal is the completion of R0 resection and normal liver function maintenance. Conversional (neoadjuvant) chemotherapy, portal vein embolization, two-stage hepatectomy, and tumour ablation are effective approaches to improve resectability for initially unresectable patients. The role of perioperative chemotherapy, for clearly resectable patients, still needs to be clarified. It results in longer disease-free survival (DFS) and OS times, but it is not clear whether it is the neoadjuvant or the adjuvant
component that provides the benefit.Disadvantages of neoadjuvant chemotherapy are either progression or complete remission during treatment, and their managment is challenging. According to available data the efficacy of adjuvant chemotherapy after CLM resection is questionable. However, the ideal chemotherapy and its optimal sequencing in the course of treatment are uncertain.Equally, the influence of chemotherapy-associated toxicity on the outcome of liver resection needs to be further explored. There is debate over whether the primary tumour and metastases should be removed at the
same time or in a staged manner. Targeted therapy with novel biological agents such as bevacizumab and cetuximab, in addition to traditional chemotherapy, has been shown to improve the survival of unresectable CLM patients. The majority of patients will develop recurrent disease in the liver within the first two years after surgery, despite any mode of treatment that they have received. Therefore, a repeat resection is recommended as the only chance to prolong DFS and OS. Consequently, all of these issues demand an modern oncosurgical and multidisciplinary approach to the each individual with
liver surgeon having a central role in treatment planning.

Keywords

colorectal cancer; liver metastases; multidisciplinary treatment; chemotherapy; R0 resection; portal vein embolization

Hrčak ID:

200571

URI

https://hrcak.srce.hr/200571

Publication date:

27.12.2013.

Article data in other languages: croatian

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