Clin Colon Rectal Surg 2009; 22(4): 225-232
DOI: 10.1055/s-0029-1242462
© Thieme Medical Publishers

Surgical Management of Colorectal Liver Metastases

Waleed M. Mohammad1 , Fady K. Balaa1
  • 1Liver and Pancreas Unit, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
Further Information

Publication History

Publication Date:
06 November 2009 (online)

ABSTRACT

Colorectal cancer is the third most commonly diagnosed cancer with approximately half of the patients developing liver metastases during the course of their disease. Modern multimodal therapies have improved the overall survival. Liver resection remains the most important modality in the treatment of colorectal liver metastases. The evolution of the criteria for resectability has resulted in more patients being offered a hepatectomy. This is further augmented with the utilization of adjuncts to liver resection, including portal vein embolization and local ablative techniques. Two-stage hepatectomy is also being used to increase resectability. Overall survival is improved by the deployment of new chemotherapeutic agents and the use of combination chemotherapy. Neoadjuvant chemotherapy is a promising development in the treatment of colorectal liver metastases. Patients with colorectal liver metastases can achieve long-term survival. A multidisciplinary approach is essential in the management of these patients.

REFERENCES

  • 1 Parkin D M, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002.  CA Cancer J Clin. 2005;  55(2) 74-108
  • 2 Steele Jr G, Ravikumar T S. Resection of hepatic metastases from colorectal cancer. Biologic perspective.  Ann Surg. 1989;  210(2) 127-138
  • 3 Scheele J, Stangl R, Altendorf-Hofmann A. Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history.  Br J Surg. 1990;  77(11) 1241-1246
  • 4 Rougier P, Milan C, Lazorthes F et al.. Prospective study of prognostic factors in patients with unresected hepatic metastases from colorectal cancer. Fondation Française de Cancérologie Digestive.  Br J Surg. 1995;  82(10) 1397-1400
  • 5 Pestana C, Reitemeier R J, Moertel C G, Judd E S, Dockerty M B. The natural history of carcinoma of the colon and rectum.  Am J Surg. 1964;  108 826-829
  • 6 Nordlinger B, Quilichini M A, Parc R, Hannoun L, Delva E, Huguet C. Hepatic resection for colorectal liver metastases. Influence on survival of preoperative factors and surgery for recurrences in 80 patients.  Ann Surg. 1987;  205(3) 256-263
  • 7 Fong Y, Fortner J, Sun R L, Brennan M F, Blumgart L H. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.  Ann Surg. 1999;  230(3) 309-318 discussion 318-321
  • 8 Choti M A, Sitzmann J V, Tiburi M F et al.. Trends in long-term survival following liver resection for hepatic colorectal metastases.  Ann Surg. 2002;  235(6) 759-766
  • 9 Abdalla E K, Vauthey J N, Ellis L M et al.. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases.  Ann Surg. 2004;  239(6) 818-825 discussion 825-827
  • 10 Viganò L, Ferrero A, Lo Tesoriere R, Capussotti L. Liver surgery for colorectal metastases: results after 10 years of follow-up. Long-term survivors, late recurrences, and prognostic role of morbidity.  Ann Surg Oncol. 2008;  15(9) 2458-2464
  • 11 Adam R, Delvart V, Pascal G et al.. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival.  Ann Surg. 2004;  240(4) 644-657 discussion 657-648
  • 12 Rosen C B, Nagorney D M, Taswell H F et al.. Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma.  Ann Surg. 1992;  216(4) 493-504 discussion 504-505
  • 13 Nordlinger B, Guiguet M, Vaillant J C Association Française de Chirurgie et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients.  Cancer. 1996;  77(7) 1254-1262
  • 14 Garden O J, Rees M, Poston G J et al.. Guidelines for resection of colorectal cancer liver metastases.  Gut. 2006;  55(Suppl 3) iii1-iii8
  • 15 Martínez L, Puig I, Valls C. Colorectal liver metastases: Radiological diagnosis and staging.  Eur J Surg Oncol. 2007;  33(Suppl 2) S5-S16
  • 16 Bipat S, van Leeuwen M S, Comans E F et al.. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis—meta-analysis.  Radiology. 2005;  237(1) 123-131
  • 17 Ruers T J, Langenhoff B S, Neeleman N et al.. Value of positron emission tomography with [F-18]fluorodeoxyglucose in patients with colorectal liver metastases: a prospective study.  J Clin Oncol. 2002;  20(2) 388-395
  • 18 Vogel W V, Wiering B, Corstens F H, Ruers T JM, Oyen W JG. Colorectal cancer: the role of PET/CT in recurrence.  Cancer Imaging. 2005;  5(Spec No A) S143-S149
  • 19 Charnley R M, Morris D L, Dennison A R, Amar S S, Hardcastle J D. Detection of colorectal liver metastases using intraoperative ultrasonography.  Br J Surg. 1991;  78(1) 45-48
  • 20 Mazzoni G, Napoli A, Mandetta S et al.. Intra-operative ultrasound for detection of liver metastases from colorectal cancer.  Liver Int. 2008;  28(1) 88-94
  • 21 Cervone A, Sardi A, Conaway G L. Intraoperative ultrasound (IOUS) is essential in the management of metastatic colorectal liver lesions.  Am Surg. 2000;  66(7) 611-615
  • 22 Wildi S M, Gubler C, Hany T et al.. Intraoperative sonography in patients with colorectal cancer and resectable liver metastases on preoperative FDG-PET-CT.  J Clin Ultrasound. 2008;  36(1) 20-26
  • 23 Pilkington S A, Rees M, Peppercorn D, John T G. Laparoscopic staging in selected patients with colorectal liver metastases as a prelude to liver resection.  HPB (Oxford). 2007;  9(1) 58-63
  • 24 Grobmyer S R, Fong Y, D'Angelica M, Dematteo R P, Blumgart L H, Jarnagin W R. Diagnostic laparoscopy prior to planned hepatic resection for colorectal metastases.  Arch Surg. 2004;  139(12) 1326-1330
  • 25 Mortensen F V, Zogovic S, Nabipour M et al.. Diagnostic laparoscopy and ultrasonography for colorectal liver metastases.  Scand J Surg. 2006;  95(3) 172-175
  • 26 Ekberg H, Tranberg K G, Andersson R et al.. Determinants of survival in liver resection for colorectal secondaries.  Br J Surg. 1986;  73(9) 727-731
  • 27 Bismuth H, Adam R, Levi F et al.. Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy.  Ann Surg. 1996;  224(4) 509-520 discussion 520-522
  • 28 Figueras J, Torras J, Valls C et al.. Surgical resection of colorectal liver metastases in patients with expanded indications: a single-center experience with 501 patients.  Dis Colon Rectum. 2007;  50(4) 478-488
  • 29 Pawlik T M, Choti M A. Surgical therapy for colorectal metastases to the liver.  J Gastrointest Surg. 2007;  11(8) 1057-1077
  • 30 Yokoyama Y, Nagino M, Nimura Y. Mechanisms of hepatic regeneration following portal vein embolization and partial hepatectomy: a review.  World J Surg. 2007;  31(2) 367-374
  • 31 Rhim H, Dodd III G D. Radiofrequency thermal ablation of liver tumors.  J Clin Ultrasound. 1999;  27(5) 221-229
  • 32 Solbiati L, Livraghi T, Goldberg S N et al.. Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients.  Radiology. 2001;  221(1) 159-166
  • 33 Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H. Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors.  Ann Surg. 2000;  232(6) 777-785
  • 34 Chua H K, Sondenaa K, Tsiotos G G, Larson D R, Wolff B G, Nagorney D M. Concurrent vs. staged colectomy and hepatectomy for primary colorectal cancer with synchronous hepatic metastases.  Dis Colon Rectum. 2004;  47(8) 1310-1316
  • 35 Martin R, Paty P, Fong Y et al.. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis.  J Am Coll Surg. 2003;  197(2) 233-241 discussion 241-242
  • 36 Adam R, Bismuth H, Castaing D et al.. Repeat hepatectomy for colorectal liver metastases.  Ann Surg. 1997;  225(1) 51-60 discussion 60-62
  • 37 Petrowsky H, Gonen M, Jarnagin W et al.. Second liver resections are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: a bi-institutional analysis.  Ann Surg. 2002;  235(6) 863-871
  • 38 Capussotti L, Ferrero A, Viganò L, Ribero D, Lo Tesoriere R, Polastri R. Major liver resections synchronous with colorectal surgery.  Ann Surg Oncol. 2007;  14(1) 195-201
  • 39 Adam R. Colorectal cancer with synchronous liver metastases.  Br J Surg. 2007;  94(2) 129-131
  • 40 Antoniou A, Lovegrove R E, Tilney H S et al.. Meta-analysis of clinical outcome after first and second liver resection for colorectal metastases.  Surgery. 2007;  141(1) 9-18
  • 41 Sa Cunha A, Laurent C, Rault A, Couderc P, Rullier E, Saric J. A second liver resection due to recurrent colorectal liver metastases.  Arch Surg. 2007;  142(12) 1144-1149 discussion 1150
  • 42 Shaw I M, Rees M, Welsh F K, Bygrave S, John T G. Repeat hepatic resection for recurrent colorectal liver metastases is associated with favourable long-term survival.  Br J Surg. 2006;  93(4) 457-464
  • 43 Adam R, Pascal G, Azoulay D et al.. Liver resection for colorectal metastases: the third hepatectomy.  Ann Surg. 2003;  238(6) 871-883 discussion 883-884
  • 44 Nishio H, Hamady Z Z, Malik H Z et al.. Outcome following repeat liver resection for colorectal liver metastases.  Eur J Surg Oncol. 2007;  33(6) 729-734
  • 45 Yamamoto J, Kosuge T, Shimada K, Yamasaki S, Moriya Y, Sugihara K. Repeat liver resection for recurrent colorectal liver metastases.  Am J Surg. 1999;  178(4) 275-281
  • 46 Cady B, Jenkins R L, Steele Jr G D et al.. Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome.  Ann Surg. 1998;  227(4) 566-571
  • 47 Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases.  World J Surg. 1995;  19(1) 59-71
  • 48 Elias D, Cavalcanti A, Sabourin J C, Pignon J P, Ducreux M, Lasser P. Results of 136 curative hepatectomies with a safety margin of less than 10 mm for colorectal metastases.  J Surg Oncol. 1998;  69(2) 88-93
  • 49 Konopke R, Kersting S, Makowiec F et al.. Resection of colorectal liver metastases: is a resection margin of 3 mm enough?: a multicenter analysis of the GAST Study Group.  World J Surg. 2008;  32(9) 2047-2056
  • 50 de Haas R J, Wicherts D A, Flores E, Azoulay D, Castaing D, Adam R. R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery?.  Ann Surg. 2008;  248(4) 626-637
  • 51 Azagra J S, Goergen M, Gilbart E, Jacobs D. Laparoscopic anatomical (hepatic) left lateral segmentectomy-technical aspects.  Surg Endosc. 1996;  10(7) 758-761
  • 52 Buell J F, Thomas M T, Rudich S et al.. Experience with more than 500 minimally invasive hepatic procedures.  Ann Surg. 2008;  248(3) 475-486
  • 53 Mala T, Edwin B, Rosseland A R, Gladhaug I, Fosse E, Mathisen O. Laparoscopic liver resection: experience of 53 procedures at a single center.  J Hepatobiliary Pancreat Surg. 2005;  12(4) 298-303
  • 54 Sasaki A, Nitta H, Otsuka K, Takahara T, Nishizuka S, Wakabayashi G. Ten-year experience of totally laparoscopic liver resection in a single institution.  Br J Surg. 2009;  96(3) 274-279
  • 55 Simmonds P C. Colorectal Cancer Collaborative Group . Palliative chemotherapy for advanced colorectal cancer: systematic review and meta-analysis.  BMJ. 2000;  321(7260) 531-535
  • 56 Delaunoit T, Alberts S R, Sargent D J et al.. Chemotherapy permits resection of metastatic colorectal cancer: experience from Intergroup N9741.  Ann Oncol. 2005;  16(3) 425-429
  • 57 De La Camara J, Rodriguez J, Rotellar F et al.. Triplet therapy with oxaliplatin, irinotecan, 5-fluorouracil and folinic acid within a combined modality approach in patients with liver metastases from colorectal cancer.  J Clin Oncol. 2004;  22(14S) 3593
  • 58 Kemeny N. Presurgical chemotherapy in patients being considered for liver resection.  Oncologist. 2007;  12(7) 825-839
  • 59 Nordlinger B, Sorbye H, Glimelius B EORTC Gastro-Intestinal Tract Cancer Group et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial.  Lancet. 2008;  371(9617) 1007-1016
  • 60 Benoist S, Brouquet A, Penna C et al.. Complete response of colorectal liver metastases after chemotherapy: does it mean cure?.  J Clin Oncol. 2006;  24(24) 3939-3945
  • 61 Adam R, Wicherts D A, de Haas R J et al.. Complete pathologic response after preoperative chemotherapy for colorectal liver metastases: myth or reality?.  J Clin Oncol. 2008;  26(10) 1635-1641
  • 62 Poston G J, Figueras J, Giuliante F et al.. Urgent need for a new staging system in advanced colorectal cancer.  J Clin Oncol. 2008;  26(29) 4828-4833
  • 63 Metcalfe M S, Mullin E J, Maddern G J. Choice of surveillance after hepatectomy for colorectal metastases.  Arch Surg. 2004;  139(7) 749-754
  • 64 Tomlinson J S, Jarnagin W R, DeMatteo R P et al.. Actual 10-year survival after resection of colorectal liver metastases defines cure.  J Clin Oncol. 2007;  25(29) 4575-4580

Fady K BalaaM.D. 

Liver and Pancreas Unit, The Ottawa Hospital, University of Ottawa

737 Parkdale Ave., Ste. 305, Ottawa, Ontario, Canada K1Y 1J8

Email: fbalaa@toh.on.ca

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