Multimodal management of colorectal liver metastases and the effect on regeneration and outcome after liver resection

Abstract

Management of colorectal liver metastases (CRLM) has dramatically changed during the last decade and has now become more multimodal and aggressive, including the use of downstaging chemotherapy, portal vein embolization to increase the function of the liver remnant or both in combination. Radiofrequency ablation is also an option in CRLM, potentially combined with surgical resection. Results are quite convincing concerning the safety of liver resection also when performed following neoadjuvant chemotherapy. Sparing liver parenchyma in patients with bilobar liver metastatic disease subjected to liver resection may be possible without endangering surgical radicality. Sparing liver parenchyma when using neoadjuvant chemotherapy, a chemotherapy-free period of 6 weeks or more seems to positively affect liver regeneration. There is still the possibility to reresect recurrent liver lesions, though there seems to be a tendency toward fewer reresections following the use of adjuvant chemotherapy.

Are sarcopenia, obesity and sarcopenic obesity predictive of outcome in patients with colorectal liver metastases?

“…A liver resection for colorectal liver metastases (CRLM) is increasingly being performed. The criteria for resectability have been expanded as a result of improved surgical possibilities, more effective chemotherapy and improved peri‐operative care . As a result, more extensive parenchymal resections are now performed.…”

“…The criteria for resectability have been expanded as a result of improved surgical possibilities, more effective chemotherapy and improved peri-operative care. [1][2][3] As a result, more extensive parenchymal resections are now performed. As a consequence the risk of post-resectional liver failure and other major complications has increased.…”

Fate and Effect of Intravenously Infused Mesenchymal Stem Cells in a Mouse Model of Hepatic Ischemia Reperfusion Injury and Resection

“…Liver transplantation (LTx) is the only life-saving treatment for end-stage hepatic diseases [ 6 ] and a treatment for patients with a primary liver tumor or colorectal metastases [ 7 – 9 ]. However, ischemia reperfusion injury (IRI), caused by interruptions of the hepatic blood flow, is inevitable during LTx and liver resection.…”