The results of surgical treatment of metastatic liver tumor

Abstract

INTRODUCTIONLiver is an organ, which, most often, metastasizes from the colorectal carcinoma, breast carcinoma, malignant lung tumor, and malignant genitourinary tract tumor. Surgery of liver metastases is indicated if the disease is limited to liver, when the primary tumor was radically removed. In some specific cases, a synchronized resection of the primary tumor (most often colon tumor) and resection of the metastatic disease are performed. This is the reason why the diagnostics of the extrahepatic disease, after any surgically treated malignity, is of primary importance before consideration of any surgery of metastases (1-3). Metastases appearing only in liver are rare and mostly originate from the colorectal carcinoma. The only therapy, which may lead to healing, is surgical removal of metastases. In everyday surgical practice, the number of patients, operated on due to liver metastases of the colorectal carcinoma is very small in comparison to frequency of the primary carcinoma and its tendency to metastasize (4,5). Unfortunately, at this moment, surgical resection of colorectal carcinoma metastases is possible in only 15% to 25% of cases (6,7). Operative treatment of liver metastases is justified only if there is a probability that healing is achievable. In practice, unfortunately, it is difficult to define the term probability of healing because the published papers sometimes lack details. Excision of one or more metastases from liver can be performed only if all the observed metastatic changes can be removed and if there is no such metastatic change left, which is not visible during the operation, but which is confirmed by visual techniques. In practice, this means that not only those metastases, easily visible should be removed.Those barely visible or invisible should not be left over. Basic indications for liver resection due to liver metastases are that they are not present in other organs, such as lungs or brain. Besides this, it is performed in all other cases, regardless the number of metastases, if after resection, there is, at least 25% of total volume of healthy liver tissue left, i.e. about 40% of total liver volume if the aggressive neoadjuvant therapy was applied (8, 9). Local recurrences of rectal tumor in pelvis minor and carcinosis of diaphragm are not contraindications for liver resection if a protective clearance up to a healthy tissue can be achieved. These principles, when they are respected, give good results and five-year survival is from 30% to 40% (7-13). About 25% of patients with colorectal carcinoma show presence of portogenic metastases in liver during the initial operation. Metachronous metastases are discovered later, after the initial operation, and they occur in 30% of patients. Synchronous metastases of colorectal carcinoma may be removed during the initial surgery or after some time by a new surgery (13). Chemotherapy and biological therapy may increase an overall resectability rate, which enables the surgeons to perform resection in additional 15% to 30% of patients wit...

Hepatectomy: Indications and Results

“…Despite improvements in chemoembolization, cryosurgery and other modalities of treatment, liver resection remains the procedure of choice in the management of most primary liver tumors [7]. Liver transplantation is the best approach in selected cases, mainly in patients with liver cirrhosis and small tumors [8].…”