Operative management of colorectal liver metastases.
In this review, the authors describe the management of patients with colorectal liver metastases in the era of effective chemotherapies and advanced interventional radiology. They give special attention to the surgical procedures that decrease the operative mortality and morbidity and produce clear margins. They discuss the best timing for chemotherapy, resection of the primary tumor, and resection of the liver metastases in an effort to improve long-term survival. The use of preoperative portal vein embolization, two-stage hepatectomy for bilobar synchronous liver metastases, and the liver-first strategy have allowed for treatment of patients with advanced disease with a curative intent, and to obtain 5-year overall survival of 30 to 60% despite poor prognostic factors and a cure (no recurrence at 10 years) in more than 20% of patients. These rates would have been unimaginable only two decades ago.
Divisions of Transplantation and Visceral Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland. gilles.mentha@hcuge.ch
Gilles
G
Mentha
Sylvain
S
Terraz
Axel
A
Andres
Christian
C
Toso
Laura
L
Rubbia-Brandt
Pietro
P
Majno
D017024:Chemotherapy, Adjuvant; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D004621:Embolization, Therapeutic; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual; D015641:Radiography, Interventional; D016896:Treatment Outcome