Hepatic resection after down-staging of unresectable hepatic colorectal metastases.
Half of the patients with colorectal cancer present with liver metastases at some point in their illness. Surgical resection, which offers the only chance of long-term survival, is an option in only 15% of patients at presentation. Novel chemotherapeutic treatments have enabled approximately 15% of those patients initially deemed inoperable to be down-staged to a point where surgery becomes an option. This aggressive approach, which requires close collaboration between surgeons and oncologists, results in a 40% 5-year survival rate, which is similar to that of patients operated without neoadjuvant chemotherapy. The hope for the future is the development of more effective chemotherapeutic regimens, which may allow more previously unresectable patients to benefit from curative surgery. This article reviews the literature and major areas of progress in treatments for unresectable colorectal cancer.
Adam
René
R
Department of Surgery, Centre Hépato-biliaire, Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier, 94804 Villejuif, France. rene.adam@pbr.ap-hop-paris.fr
Huguet
Emmanuel
E
Azoulay
Daniel
D
Castaing
Denis
D
Kunstlinger
Francis
F
Levi
Francis
F
Bismuth
Henri
H
D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D005472:Fluorouracil / Q000627:therapeutic use*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D016019:Survival Analysis
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil