For citation purposes: Choong KC, Ammori JB. Surgical management of colorectal liver metastases. OA Cancer 2014 Mar 10;2(1):6.

Review

 
Surgical Intervention

Surgical management of colorectal liver metastases.

K Choong, J Ammori
 

Authors affiliations

(1) University Hospitals Case Medical Center, Cleveland, USA

* Corresponding author Email: john.ammori@uhhospitals.org

Abstract

Introduction

Colorectal cancer is the fourth most common malignancy and the second most common cause of cancer related death in the United States. In patients with colorectal liver metastases who are candidates for resection, surgical resection provides optimal clinical outcomes and the only chance for cure. As such, this article will review current knowledge in the surgical management of colorectal liver metastases.

Discussion

Surgical resection has been shown to be the most effective treatment for colorectal liver metastases. As such, evaluation for resectability is of the utmost importance during initial work-up. Improved chemotherapeutic regimens in addition to recent advances in the surgical techniques, such as staged resections, portal venous embolism, ablation and minimally invasive surgery have expanded the indications for resection while reducing the morbidity and mortality of hepatic resections and improving survival rates. Repeat hepatectomy for resectable recurrence has also been shown to improve survival. In addition, select patients with extrahepatic disease may benefit from an aggressive surgical approach.

Conclusion

A multidisciplinary approach centred around surgical resection is safe and the most effective treatment for colorectal liver metastases. As chemotherapeutic and surgical techniques continue to improve, the definition of resectability continues to expand. Absolute contraindications to resection include inability to leave the patient with a future functional liver remnant (FLR) greater than 20-25% in a normal liver and 40% in a chemotherapy-injured liver, and the inability of the patient to tolerate surgery due to medical comorbidities or poor functional status.

Licensee OA Publishing London 2014. Creative Commons Attribution License (CC-BY)
Keywords