title: Treatment for multiple bilobar liver metastases of colorectal cancer.
abstract: BACKGROUND
  Recent advances have extended indications for hepatectomy to include multiple bilobar colorectal liver metastases (CLM). Staging systems based on the biological malignancy of primary and metastatic tumors provide appropriate indications for hepatectomy in CLM. However, suitability for resection in patients with complex and extensive hepatic metastases is controversial.
  
  
  METHODS
  A medline search was performed to identify papers reporting the resection for CLM. Techniques, indication, and results were reviewed.
  
  
  RESULTS
  If the anticipated remnant liver volume is small (25-40% of total), suggesting a high risk of postoperative liver failure, portal vein embolization (PVE) is recommended prior to hepatectomy. However, curative resections are not always possible. Specifically in synchronous multiple bilobar CLM, two-stage hepatectomy, comprising bilateral hepatectomy and primary resection with or without PVE, can prevent growth of ipsilateral metastatic nodules in the remnant liver and reduce surgical risk. Several local ablation techniques can complement surgery if hepatic resection alone increases the risk of postoperative liver failure or is not curative. Chemotherapy combined with targeted treatment can suppress recurrence and extend indications for hepatectomy by reducing the size and number of primary irresectable tumors.
  
  
  CONCLUSIONS
  PVE or staged procedure combining with local ablation or neoadjuvant, downstaging or adjuvant therapies extends indications for hepatectomy to include multiple bilobar CLM. The 5-year survival rate for multiple bilobar CLM treated with alternating hepatectomy and chemotherapy is comparable to the values reported for single and hemilateral CLM.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. hs440312@med.yokohama-cu.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D017115:Catheter Ablation; D002425:Cautery; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D017679:Cryotherapy; D004621:Embolization, Therapeutic; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D011169:Portal Vein; D011379:Prognosis; D012086:Reoperation
chemical_list: D000970:Antineoplastic Agents