Current status and future perspectives on treatment of liver metastasis in colorectal cancer

Abstract

Liver metastasis is the most common site of colorectal cancer (CRC) metastasis. Approximately half of all colorectal cancer patients will develop liver metastases. Although radical surgery is the standard treatment modality, only 10-20% of patients are deemed eligible for resection. Despite advances in survival with chemotherapy, surgical resection is still considered the only curative option for patients with liver metastases. Much effort has been expended to address patients with metastatic liver disease. The majority of evidence stated a significant survival benefit with surgical resection to reach an overall 5-year survival rate of 35-55% after hepatic resection. However, still majority of patients will experience disease recurrence even after a successful resection. In this review, we describe current status and controversies related to treatment options for CRC liver metastases and its potential for enhancing oncologic outcomes and improving quality of life.

Metastatic gastric cancer: Does the site of metastasis make a difference?

“…Advancements in the management of metastatic intraabdominal malignancies seeking not just to palliate but to push boundaries on achieving significant improvements in overall survival have been contingent upon the identification of subgroups of each metastatic malignancy who may best benefit from targeted, multimodality therapeutic interventions. Examples include the application of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal, appendiceal mucinous neoplasms and ovarian metastases to the peritoneum, and the use of metastasectomy in isolated colorectal and neuroendocrine metastases to the liver . With the growing interest in improving survival outcomes in patients with metastatic gastric cancer, it is hence imperative that we examine how the site(s) of metastasis and other clinical features affect the clinical course and overall survival of metastatic gastric cancer patients.…”

“…In pushing the frontiers of managing patients with metastatic disease to achieve further improvements in long‐term survival, we have seen notable results best characterized by colorectal cancer. Colorectal cancer patients with limited metastatic disease isolated to a single site amenable to surgical resection have been shown to benefit from a multimodality approach encompassing systemic chemotherapy, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy …”

Nonresectional regional therapies for metastatic colorectal cancer to the liver

“…Hepatic resection When feasible, surgical resection is currently the treatment of choice. 1,2 Must be a surgically fit patient with sufficient residual hepatic function.…”

“…1 Since then, it has become established that major hepatectomy in well-selected patients with hepatic metastases from colorectal cancer portents a survival advantage. 2 Unfortunately, only 20% of patients with isolated liver metastases from colorectal cancer undergo surgical resection. 3 Selecting patients for surgery takes into account functional status, baseline liver function as well as extent of intrahepatic and extrahepatic disease.…”

Recent advances in treatment for colorectal liver metastasis

“…However, if the metastases are assessed as resectable, surgery is carried out, whereas systemic chemotherapy followed by evaluations for resectability every 2 months is recommended for unresectable liver metastases. Even cases with multiple metastases can now be cured after resection as a result of recent advances in operative methods and chemotherapy …”