[Hepatic metastasis of colorectal cancer--current therapeutic possibilities].
In this article we presented the therapeutical modalities available nowadays for the treatment of patients with colorectal liver metastases (CRLM), based on a wide search in the literature. To date, due to the developments in liver surgery, anesteziology and intensive care therapy, chemotherapy, interventional radiology and radiationtherapy, the treatment of CRLM is multimodal. These advances led to a changing of the definition of the resectability, in present, resectability being defined by the quality and volume of the functional liver remnant after hepatectomy. In the last years, the timing of liver resection was recconsidered, hepatectomy being suitable (especially in patients with multiple CRLM) after neoadjuvant chemotherapy, and in patients with synchronous CRLM, resection of the primary tumor and liver metastases is reccomended to be performed simultaneously whenever this approach is safe and allows a complete resection of the tumoral tissue. Presence of the extrahepatic colorectal metastases do not represent a contraindication to liver resection, as long as complete removal of the metastases is possible. Conversion to resectability was possible for about 30% of the patients with initially unresectable CRLM, using several therapeutical strategies, giving the chance of a long-term survival to these patients. Liver re-resection is the treatment of choice for patients with recurrent liver metastases, survival rates being similar to those achieved after the first liver resection. Hyperthermic ablation is recommended in patients whose CRLM could not be resected, but the results seem to be inferior to those achieved by liver resection.


CONCLUSIONS
In present, the treatment of CRLM is multimodal, involving the surgeon, oncologist, radiotherapist and radiologist. Taking into account the great variability of the patients and the multiple therapeutical possibilities, the treatment should be taylored to each patient.
Centrul de Chirurgie Generală şi Transplant Hepatic, Institutul Clinic de Boli Digestive si Transplant Hepatic Fundeni Bucureşti, România. irinel.popescu@icfundeni.ro
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Alexandrescu
D017115:Catheter Ablation / Q000379:methods; D016461:Chemoembolization, Therapeutic / Q000379:methods; D017024:Chemotherapy, Adjuvant / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D004621:Embolization, Therapeutic / Q000379:methods; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D018579:Patient Selection; D018714:Radiotherapy, Adjuvant / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome