Conversion Rate to Resectability in Colorectal Cancer Liver Metastases: Need for Criteria Adapted to Current Therapy.

Abstract

Research ArticleOpen Access IntroductionColorectal cancer is the third most common cancer worldwide among men (incidence 21 per 100,000 and mortality rate 10 per 100,000) and the second among women (incidence 15 per 100,000 and mortality rate 8 per 100,000). In Central and Eastern Europe, the incidence is 35 per 100,000 men and 22 per 100,000 women and mortality rate 20.3 per 100,000 men and 11.7 per 100,000 women. The overall 5 year survival rate is 50-60% [1].These rather disappointing results are mainly due to (remote) secondary lesions that most commonly affect the liver. Liver metastases occur in approximately 50% of all patients with CRC and represent the main cause of death. They are present in 15-25% of patients at the time of diagnosis [2][3][4].Despite the recent progress in the multi-disciplinary treatment for stage IV CRC, the 5-year survival is only 6% However, the survival rate has improved considering that 10 years ago, stage IV CRC was associated with a 5-year survival of less than 1% [5].Surgical treatment -the resection of metastases -remains the only curative treatment for CRLM. The complete resection of all liver metastases improves the overall survival from 25% (R1) to 40% (R0) [4,6]. Granting all this, the relapse / recurrence rate after curative liver resections remains high, ranging from 50% to 70% [7 ].These fluctuations in survival rate are mainly related to the selection of the indications for liver resection. The benefits are due to the imaging techniques, which offer a better choice of surgical procedures. Also, the development of other complementary techniques (portal vein embolization, thermoablation) and oncological therapies (chemotherapy, molecular therapy) have increased patient eligibility AbstractBackground: Therapeutic strategy for patients with colorectal cancer liver metastases (CRLM) is based on good monitoring and correct assignment to classes of liver resectability based on imaging criteria, taking into account the surgical risk.Objective: To identify the post-treatment time frame for confirming resectability (conversion to resecability) or permanent unresectability. Methods:The study is a prospective analysis based on a Scientific Protocol (Surveillance of patients with colorectal cancer liver metastases) used in the Ist Surgical Oncology Unit, Regional Institute of Oncology Iaşi, Romania. Surgical treatment, oncologic treatment, response to therapy , postoperative surgical complications, were assessed at 3, 6 and 9 months after start of the study. Results:In the interval July 2012 -January 2014, 106 patients were diagnosed with CRLM. According to the classes of liver resectability the patients were divided into four groups: group I (clear resectability), group II (possibly resectability), group III (susceptible resectability), group IV (unresectable metastases). Relevant for the study were only groups II and III. Thus, in group II patients the rate of conversion to resectability was 23.07% and in group III patients 26.66%. These results were obtained after 3, 6 and ...