Metastatic lesions to the liver: Surgical indications and techniques

Abstract

Background: Although there is an established agreement on the advantage of liver resection for metastatic colorectal and neuroendocrine tumours, the role of hepatic surgery in patients with liver metastases from non-colorectal and non-neuroendocrine carcinoma is not well defined. In recent years, despite the poor results, liver metastases suitable for surgery have been treated with resection. The results reported in recent studies support a developing trend toward surgery in this setting. Also, as there are no data that in fact suggest the utility of alternative treatments for these lesions, the role of surgery is reinforced. Methods:A systematic search of English and non-English literature using MEDLINE on the outcomes of patients after surgical treatment of liver metastases from different solid tumours was undertaken. A summary of current surgical techniques used to improve their resectability has been added.Results: All papers reporting median survival and 5-year survival have been selected and presented in tables for most of the primary tumours reviewed. Conclusions:Apart from patients with colorectal and neuroendocrine tumours, liver resection may offer a significative survival advantage in selected patients, mainly those with metastases coming from breast, gastrointestinal stromal tumours, testis, ovary and kidney.

Appendix A from MTL-CEBPA, a Small Activating RNA Therapeutic Upregulating C/EBP-α, in Patients with Advanced Liver Cancer: A First-in-Human, Multicenter, Open-Label, Phase I Trial

“…Several studies have shown 5-year survival rates of up to 86% in R0 resection for both primary and secondary sites. Cytoreduction is useful as a palliative approach (57). RFA is shown to relieve symptoms in 60% of the cases with local disease control in 80%, although the length of response is short (57).…”

“…Cytoreduction is useful as a palliative approach (57). RFA is shown to relieve symptoms in 60% of the cases with local disease control in 80%, although the length of response is short (57). Transarterial chemoembolisation (TACE), also has a short duration of response (57).…”

“…RFA is shown to relieve symptoms in 60% of the cases with local disease control in 80%, although the length of response is short (57). Transarterial chemoembolisation (TACE), also has a short duration of response (57). There is also a risk of causing carcinoid tumour lysis syndrome or crises.…”