I Brazilian Consensus on Multimodal Treatment of Colorectal Liver Metastases. Module 2: Approach to Resectable Metastases

Abstract

Background: Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients. Aim: In the second module of this consensus, management of resectable liver metastases was discussed. Method: Concept of synchronous and metachronous metastases was determined, and both scenarius were discussed separately according its prognostic and therapeutic peculiarities. Results: Special attention was given to the missing metastases due to systemic preoperative treatment response, with emphasis in strategies to avoid its reccurrence and how to manage disappeared lesions. Conclusion: Were presented validated ressectional strategies, to be taken into account in clinical practice.

Evolution in the surgical management of colorectal liver metastases: Propensity score matching analysis (PSM) on the impact of specialized multidisciplinary care across two institutional eras

“…Another prerequisite for surgery was an estimated adequate future liver remnant (over 25% in healthy livers and over 30% after long‐term exposure to chemotherapy) . Patients with initially unresectable liver metastases or presenting with worrisome prognostic features (ie, synchronous metastases, multiple nodules, and elevated carcinoembryonic antigen [CEA]) were initially managed with systemic treatment, but otherwise, resectable patients with signs of better biological behavior were directly scheduled for hepatectomy . Limited extra‐hepatic disease, whenever deemed resectable, was not considered a contraindication .…”

“…17,18 Patients with initially unresectable liver metastases or presenting with worrisome prognostic features (ie, synchronous metastases, multiple nodules, and elevated carcinoembryonic antigen [CEA]) were initially managed with systemic treatment, but otherwise, resectable patients with signs of better biological behavior were directly scheduled for hepatectomy. 19 Limited extra-hepatic disease, whenever deemed resectable, was not considered a contraindication. 20 Patients were followed up on as per institutional protocol with cross-sectional imaging and CEA levels every 4-6 months for the first 2 years and annual screening and consultations every 6 months thereafter.…”

Características sociodemográficas e clínicas de pessoas adoecidas por câncer colorretal submetidas ao tratamento cirúrgico

“…Mas o CCR pode acometer diversos órgãos. No presente estudo, foram identificados poucos casos de metástases descritos em prontuário 4 (12,1%), o que dificulta uma maior análise sob este fator de complicação (Ribeiro et al, 2016).…”

Metachronous Colorectal Liver Metastases Has Better Prognosis - Is It True?

“…Hepatic metastases may be present from the diagnosis of primary colorectal neoplasia or even be diagnosed before it. In this case, they are called synchronous metastases when they occur in the first 6 months after diagnosis of primary colorectal neoplasia (4) . Metastases diagnosed after 6 months are called metachronous (4) .…”

“…In this case, they are called synchronous metastases when they occur in the first 6 months after diagnosis of primary colorectal neoplasia (4) . Metastases diagnosed after 6 months are called metachronous (4) . However, this definition is heterogeneous, since other time intervals are adopted between the diagnosis of the primary tumour and of the liver metastasis, ranging from 0 to 12 months (5) .…”