The surgical treatment of hepatic metastases in colorectal carcinoma.
BACKGROUND
Colorectal carcinoma with hepatic metastases was long considered an incurable disease. Recent advances in surgical treatment have substantially improved the affected patients' prognosis. At first, surgery was only performed in patients whose hepatic tumor burden was small (<4 nodes, <5 cm). Currently, however, the main issue is the feasibility of curative resection of all metastases.


METHODS
The PubMed literature database was selectively searched for articles with the keywords "colorectal liver metastases," "chemotherapy," and "surgery." Particular attention was devoted to studies of large groups of patients, randomized trials, the German guidelines, and an analysis of the authors' own patient population.


RESULTS
Only 10% to 20% of all patients are candidates for surgical therapy (hepatic resection), as the rest are disqualified either by extensive liver involvement or by extrahepatic neoplasia. A further 10% of patients have hepatic metastases that are primarily considered inoperable, yet later become amenable to surgery after interdisciplinary treatment involving preoperative chemotherapy, portal-vein embolization, two-stage hepatectomy, and/or locally ablative procedures. Chemotherapy is probably beneficial after hepatic resection, although the benefit has not yet been definitively demonstrated by clinical trials. Therefore, chemotherapy should only be given perioperatively in selected cases, when recommended by an interdisciplinary treatment team.


CONCLUSIONS
A multimodal approach to the treatment of hepatic metastases of colorectal carcinoma has led to an increase in the number of resections and to an improved long-term survival rate (currently more than 40% at 5 years).
Neumann
Ulf Peter
UP
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany. chirurgie@ukaachen.de
Seehofer
Daniel
D
Neuhaus
Peter
P
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D020360:Neoadjuvant Therapy; D010348:Patient Care Team; D011169:Portal Vein; D011379:Prognosis; D047368:Tumor Burden
D000970:Antineoplastic Agents