Optimizing the approach to patients with potentially resectable liver metastases from colorectal cancer.
Liver metastases are a common event in colorectal carcinoma. Significant advances have been made in managing these patients in the last decade, including improvements in staging and surgical techniques, an increasing armamentarium of chemotherapeutics and multiple local ablative techniques. While combination chemotherapy significantly improves median patient survival, surgical resection provides the only prospect of cure and is the focus of this review. Interpretation of published work in this field is challenging, particularly as there is no consensus to what is resectable disease. Of particular interest recently has been the use of neoadjuvant treatment for downstaging and downsizing disease in patients with initially unresectable liver metastases, in the hope of response leading to potentially curative surgery. This review summarizes the recent developments and consensus guidelines in the areas of staging, chemotherapy, local ablative techniques, radiation therapy and surgery, emphasizing the multidisciplinary approach to this disease and ongoing controversies in this field and examines the changing paradigms in the management of colorectal hepatic metastases.
Lim
Elgene
E
The Walter & Eliza Hall Institute of Medical Research, Department of Surgery, Royal Melbourne Hospital, Victoria, Australia.
Thomson
Benjamin N J
BN
Heinze
Stefan
S
Chao
Michael
M
Gunawardana
Dishan
D
Gibbs
Peter
P
D000970:Antineoplastic Agents / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000473:pathology*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D018579:Patient Selection; D011300:Preoperative Care; D011379:Prognosis; D016019:Survival Analysis
D000970:Antineoplastic Agents