Role of surgery in colorectal cancer liver metastases

Abstract

Colorectal carcinoma (CRC) is the third most common cancer, and approximately 35%-55% of patients with CRC will develop hepatic metastases during the course of their disease. Surgical resection represents the only chance of long-term survival. The goal of surgery should be to resect all metastases with negative histological margins while preserving sufficient functional hepatic parenchyma. Although resection remains the only chance of long-term survival, management strategies should be tailored for each case. For patients with extensive metastatic disease who would otherwise be unresectable, the combination of advances in medical therapy, such as systemic chemotherapy (CTX), and the improvement in surgical techniques for metastatic disease, have enhanced prognosis with prolongation of the median survival rate and cure. The use of portal vein embolization and preoperative CTX may also increase the number of patients suitable for surgical treatment. Despite current treatment options, many patients still experience a recurrence after hepatic resection. More active systemic CTX agents are being used increasingly as adjuvant therapy either before or after surgery. Local tumor ablative therapies, such as microwave coagulation therapy and radiofrequency ablation therapy, should be considered as an adjunct to hepatic resection, in which resection cannot deal with all of the tumor lesions. Formulation of an individualized plan, which combines surgery with systemic CTX, is a necessary task of the multidisciplinary team. The aim of this paper is to discuss different approaches for patients that are treated due to CRC liver metastasis.

Spillage of bacterial products during colon surgery increases the risk of liver metastases development in a rat colon carcinoma model.

“…Unfortunately, in a sub-population of patients, who do not have evidence of metastatic disease at the time of resection, liver metastases will develop post-operatively. 3, 4 This supports that these patients had either undetectable micro-metastases or circulating tumor cells, which can grow out into distant metastases after successful removal of the primary tumor. It has been suggested that surgery increase the risk of liver metastases development.…”

“…2 Additionally, ~10-25% of the patients who do not have evidence of metastatic disease at the time of resection and as such are eligible for curative surgery, will nonetheless develop colorectal liver metastases within five years. 3, 4 …”

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict chemotherapy outcomes and prognosis in patients with colorectal cancer and synchronous liver metastasis

“…The number of liver metastases was categorized according to the criteria between minor and major lesions [15]. Regarding pathologic diagnosis, expression of MLH1, MSH2, MLH6, and PMS2 was routinely evaluated.…”

Surgery for Liver Metastases from Breast Cancer

“…Abbot [6] 57 14 Adam [7] 41 46 17 Belda [8] 17 23 Caralt [9] 36 Carlini [10] 53 46 d'Annibale [11] 70 Duan [12] 67 43.8 Elias [13] 34.3 50 34 22 Ercolani [14] 40 Furka [15] Groeschl [16] 52 Hoffmann [17] 68 48 34 Kollmar [18] 50 Kondo [19] 60 40 Kostov [20] 43 84 64 38 29.4 Lendoire [21] 53 78 Lorenz [22] 15 12 Lubrano [23] 42 94 61 33 54 Maksan [24] 51 Okaro [25] 31 O'Rourke [26] Pocard [27] 90 71 Raab [28] 27 50 18.4 Reddy [29] 67 24 Rubino [30] 74 88 88 76 60 66 Sakamoto [31] 25 52 21 Schneebaum [32] 42 Seifert [33] 57 53.6 Selzner [34] 24 22 Stehlin [35] 28 11 Thelen [36] 77 50 42 van Walsum [37] 55 37 19 Vlastos [38] 25 86 61 Weitz [39] 48 15 Yedibela [40] Yoshimoto [41] 34 [44,45]. Conversely, surgeons have been historically reluctant to performing hepatic resection for liver metastases from noncolorectal/non-neuroendocrine cancers.…”