Perioperative Systemic Chemotherapy for Colorectal Liver Metastasis: Recent Updates

Abstract

The liver is the most common site of metastases for colorectal cancer. Complete resection in some patients with resectable liver metastases (LM) can lead to long-term survival and cure. Adjuvant systemic chemotherapy after complete resection of LM improves recurrence-free survival; however, the overall survival benefit is not clear. In selected patients, preoperative systemic treatment for metastatic colorectal cancer can convert unresectable to resectable cancer. This review will focus on patient selection, and integration of perioperative and postoperative systemic treatment to surgery in resectable and initially unresectable LM. Additionally, new drugs and biomarkers will be discussed.

Intrabiliary metastasis of colorectal mucinous adenocarcinoma mimicking choledocholithiasis 18 years after the primary tumor

“…In cases where oxaliplatin-based therapy was previously administered, observation may be considered [22] . However, while there is an increase in disease-free survival, perioperative chemotherapy has not been shown to improve overall survival in patients who undergo resection for colorectal liver metastasis [23] . Moreover, in intricate and unique cases such as this, the role of systemic treatment is truly unknown and a multidisciplinary tumor board discussion is crucial to incorporate perspectives from different specialties for a patient-centric approach.…”

Multimodal Management of Colorectal Liver Metastases: State of the Art

“…A residual volume liver ≥30% is required for patients who received chemotherapy, while ≥40% with liver fibrosis or cirrhosis [ 28 ]. The European Group for the Treatment of Colorectal Metastases (ECMTG) proposes that resection should be considered for patients with more than 30% post-surgery liver volume, and absence of either celiac lymph node involvement, unresectable extrahepatic disease, invasion of the hepatic hilum or the inferior vena cava, as well as the simultaneous involvement of all hepatic veins [ 3 ].…”

“…Fong [10] Nordlinger [11] Nagashima [12] Konopke [13] CERR [14] R1 resection includes surgical margins ≤1 mm, while R2 resection refers to macroscopically incomplete resection [9]. The definition of LM resectability changed over time depending on clinical and radiological parameters, such as number, size and site of metastases, as well as node, vascular involvement and patient's performance status [3]. In this context, the most important factor to define a patient with CRLM as resectable implies the maintenance of an adequate residual liver function after resection, considered as the preservation of at least two contiguous liver segments with sufficient blood flow, biliary drainage, and >20% residual liver of the total volume [27].…”

“…Colorectal cancer (CRC) is one of the most common malignancies [ 1 ] accounting 10% of global cancer incidence and 9.4% of cancer deaths worldwide [ 2 ]. More than half of patients develops metastases from CRC and the majority of them carry liver metastases (CRLM) [ 3 , 4 ].…”

Current Surgical Management Strategies for Colorectal Cancer Liver Metastases

“…Colorectal cancer is the third most common cancer diagnosis in the world [ 1 ], and the second most common cause of cancer-related deaths [ 2 ]. Over the last several decades we have seen significant progress in management strategies for colorectal cancer; screening modalities have improved [ 3 ], new systemic treatment options have lengthened survival [ 4 ], and recent developments in surgical management strategies have expanded resection eligibility criteria [ 5 , 6 ]. Despite this progress, metastatic disease remains the most common cause of death [ 7 ].…”