Treatment for multiple bilobar liver metastases of colorectal cancer.
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.
Shimada
Hiroshi
H
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
Tanaka
Kuniya
K
Matsuo
Kenichi
K
Togo
Shinji
S
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
D000970:Antineoplastic Agents