COLORECTAL LIVER METASTASES PROGRESSING DURING CHEMOTHERAPY IS THERE A ROLE FOR RESECTION? SYSTEMATIC REVIEW

Introduction: The treatment of colorectal liver metastases (CRLM) had surgery as the main curative strategy. However, chemotherapy (QT) has helped to improve survival and surgical treatment conditions. Patients with good QT response has more chance to resection and those with disease progression (DP) during preoperative treatment may have surgery contraindicated. The aim of this study is to review the literature to assess whether there is a role for surgery in the treatment of patients with disease progression during QT. Methods: The research was performed in 3 databases (MEDLINE, SCOPUS, Web of Science) until July 10, 2019, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). One thousand and thirty-one studies were found using the search: (Progression OR "Disease Progression") AND (Surgery OR hepatectomy OR "liver resection") AND ("Colorectal Liver Metastases" OR "Colorectal Liver Metastasis"). No filters applied. Results: One thousand and thirty-one studies were found and after excluding duplicates and irrelevant articles for this work, 15 were selected. Of these 15, 10 indicate DP during or after QT as a negative prognostic factor on survival of patients with liver metastases of CRLM. The overall survival of patients undergoing liver resection after DP during QT ranged from 8 to 40.1% at 5 years. This review also shows as negative prognostic factors, those patients with high tumor markers (CEA, CA 19-9), higher number of secondary lesions, larger size of metastases, high tumor grade, mutated RAS and shorter disease-free interval. Some authors show no difference in overall survival between patients undergoing hepatectomy who did or did not respond to preoperative QT. Others author have shown benefit when operating DP patients with lesions up to 5 cm, up to 3 lesions and CEA up to 200 ng / dL. Conclusion: Although DP during QT is an independent negative prognostic factor, some patients may benefit with surgery based on the role of this modality as the main treatment with curative intent for patients with CRLM. In selected cases, based on size, number of lesions and tumor markers, surgery may be offered despite the less favorable prognosis and as an option for non-QT responders.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019