title: Challenges in the multidisciplinary management of stage IV colon and rectal cancer.
abstract: Colorectal metastases still represent a challenge to all oncologists despite progresses achieved by improved resectability, systemic chemotherapy and targeted therapies. In particular in patients with oligo-metastases, the role of surgical resections has been redefined. Resection is the most effective treatment method for liver metastases performed with curative intent; however, primary rate of resectability is low. Several methods to increase resectability have been developed: conversion chemotherapy, portal vein embolization, two-stage resections, vascular reconstruction of the liver veins, combination of resection and intraoperative ablation. Liver resections can be performed at present with low mortality. Patients with isolated peritoneal metastases, no extra-abdominal disease, low volume tumor and complete surgical cytoreduction do benefit from surgery and hyperthermic intraperitoneal chemotherapy. Several national guidelines recommend multimodality treatment for highly selected patients. The management of stage IV colorectal cancer includes several disciplines with focus on resection. A multidisciplinary evaluation of all patients is of crucial importance to define the treatment sequence and individual strategies for each patient.
authors.affiliation: Department for General- and Visceral Surgery, Hospital Barmherzige Brueder, Pruefeninger Str. 86, 93049 Regensburg Germany.
authors.forename: Pompiliu
authors.initials: P
authors.lastname: Piso
authors.forename: Dirk
authors.initials: D
authors.lastname: Arnold
authors.forename: Gabriel
authors.initials: G
authors.lastname: Glockzin
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D009367:Neoplasm Staging; D010348:Patient Care Team; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*
keywords: ALPPS; HIPEC; liver metastases; peritoneal carcinomatosis