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Review
. 2010 Apr 27;102(9):1313-8.
doi: 10.1038/sj.bjc.6605659.

Surgery for colorectal liver metastases

J N Primrose  1
Affiliations
Review

Surgery for colorectal liver metastases

J N Primrose. Br J Cancer. .

Abstract

In this review the surgery of colorectal liver metastases is discussed. It has long been known that liver surgery can cure metastatic colorectal cancer although in only a small proportion of the population with the disease. However with better understanding of the natural history of the condition and advances in technique more patients can have safe, potentially curative surgery. The multidiscipline management of patients with effective chemotherapy has led to more patients benefiting from surgery after reducing the size of the metastases and allowing operation on patients who were previously inoperable. Chemotherapy also improves at least the medium-term outcome in those who are operable at the outset. Minimally invasive techniques have been developed so that major hepatectomy may be accomplished in up to half of such cases with a very short hospital stay and limited interference with quality of life. Lastly, using portal vein embolisation to cause hypertrophy of the future liver remnant and on occasions combining it with staged liver resection allows potentially curative surgery on patients who previously could not have survived resection. These developments have led to more patients being cured of advanced colorectal cancer.

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Figures

Figure 1
Figure 1
The segments of the liver as first described by Couinaud et al (1957).
Figure 2
Figure 2
The areas of the liver most amenable to treatment by laparoscopic surgery. The grey area is accessible but those in white (mostly around the hepatic veins and the vena cava) much less so.
Figure 3
Figure 3
The technique of right portal vein embolisation. The catheter in introduced percutaneously into the main portal vein by the ipsilateral approach (A). The right portal vein is then ablated by embolising with a combination of tissue glue, microspheres and coils (B).
Figure 4
Figure 4
The liver at operation 6 weeks after portal vein embolisation. There is a clear line of demarcation in the line of the gall bladder and the inferior vena cava. The right liver is atrophic and shows signs of arterialisation.
See this image and copyright information in PMC

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MeSH terms