Complex Surgical Strategies to Improve Resectability in Borderline-Resectable Disease

Abstract

Colorectal cancer is the third most common malignancy in the USA and continues to pose a significant epidemiologic problem, despite major advances in the treatment of patients with advanced disease. Up to 50 % of patients will develop metastatic disease at some point during the course of their disease, with the liver being the most common site of metastatic disease. In this review, we address the relatively poorly defined entity of borderline-resectable colorectal liver metastases. The workup and staging of borderline-resectable disease are discussed. We then discuss management strategies, including surgical techniques and medical therapies, which are currently utilized in order to improve resectability.

Keywords: Ablation; Borderline; Borderline-resectable; Colorectal cancer; Colorectal liver metastases; Future liver remnant; Hepatectomy; Hepatic arterial infusion pump; Liver resection; Portal veinembolization; Systemic chemotherapy; Two-stage hepatectomy.