New paradigm in the management of liver-only metastases from colorectal cancer

Abstract

For patients with colorectal liver metastases, hepatic resection is the treatment of choice, and the 5-year survival rate following surgery now exceeds 50%. Timely multidisciplinary and multimodality approaches that may include preoperative systemic chemotherapy, preoperative portal vein embolization, extended hepatic resection, and two-stage hepatectomy, have enabled a large proportion of patients to undergo potentially curative treatment. The definition of resectability has shifted from a focus on tumor characteristics, such as tumor number and size, to determination of whether both intrahepatic and extrahepatic disease can be completely resected and whether such an approach is appropriate from an oncologic standpoint for a given patient. Future identification of molecular factors may aid in predicting prognosis of patients with colorectal liver metastases and in improving the selection of patients most likely to benefit from surgery. Hepatobiliary surgeons and medical oncologists should work together to individualize treatment strategies to maximize long-term survival in patients with colorectal liver metastases.

Figure 1

Survival after curative resection for colorectal liver metastases, stratified by margin status. No significant survival differences were seen in patients with negative surgical margins, regardless of the width of the margin. Reprinted with permission from Pawlik.

Figure 2

Negative effect of human telomerase reverse transcriptase (hTERT) expression on overall survival in patients undergoing curative resection for colorectal liver metastases. Patients with nucleolar hTERT staining had significantly shortened survival. Reprinted with permission from Dômont et al.

Figure 3

Complications rate stratified by standardized future liver remnant (sFLR) volume. Patients with sFLR less than 20% had significantly more complications than patients with sFLR greater than 20% (The University of Texas M. D. Anderson Cancer Center, unpublished data, 11/2/2006).

Figure 4

Overall survival of patients with colorectal liver metastases stratified by type of treatment. Long-term survival was significantly higher in resected patients. Reprinted with permission from Abdalla et al.