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Management of potentially resectable colorectal cancer liver metastases

Authors
Alan P Venook, MD
Steven A Curley, MD, FACS
Section Editor
Kenneth K Tanabe, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Approximately 132,700 Americans are diagnosed with colon or rectal cancer annually, and 49,700 will die from this disease, most with metastatic tumors [1]. Global, country-specific data on incidence and mortality are available from the World Health Organization (WHO) GLOBOCAN database.

Hepatic metastatic disease from colorectal cancer (CRC) is a significant clinical problem. The liver is the dominant metastatic site for patients with CRC, and although two-thirds of affected patients have extrahepatic spread, some have disease that is isolated to the liver. For patients with isolated liver metastases, regional treatment approaches may be considered as an alternative to or in combination with systemic chemotherapy.

The available regional treatments for hepatic metastases from CRC include surgical resection, local tumor ablation (ie, instillation of alcohol or acetic acid directly into the metastatic lesions, radiofrequency ablation [RFA]), regional hepatic intraarterial chemotherapy or chemoembolization, and radiation therapy (RT). Among these treatments, only surgery is associated with a survival plateau.

Although hepatic resection used to be reserved for patients with a maximum of three lesions in the same lobe if it was possible to achieve 1 cm margins and those without portal lymph node metastases, all of these “rules” have been challenged in the modern era, particularly with advancements in both surgical technique and systemic therapy [2]. Profound improvements in the outcomes of patients with metastatic CRC over the past 15 years have been attributed to increased use of hepatic resection in selected patients and more effective chemotherapy [3]. (See "Systemic chemotherapy for metastatic colorectal cancer: Completed clinical trials".)

As a result, the criteria for defining which patients are suited for surgical therapy have evolved, and many surgeons take an aggressive stance in the management of hepatic metastases.

                              

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Literature review current through: Jun 2015. | This topic last updated: May 20, 2015.
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