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Innere Medizin 1. März 2009

Role of interdisciplinary strategies in liver metastases

Metastases of the liver are a common event in malignancies particularly of the gastrointestinal tract and a leading cause of cancer-related death. Until a few years ago, treatment for these patients was given based on palliative strategies. Today there is considerable hope for cure owing to recent developments of both surgical techniques of liver resection and chemotherapy. Liver surgery has become a safe and widespread procedure with postoperative morbidity rate of less than 40% and mortality rate of less than 5%. At the time of diagnosis, only a small amount of patients with liver metastases are resectable. Therefore, efforts have been made to increase the proportion of resectable patients, who may be considered for potential curative resection. Besides extended surgical techniques, possibly in combination with ablative procedures, preoperative chemo- and targeted therapy have become the leading means to gain resectability. Particularly in patients with metastasis of colorectal cancer (CRC) significant advances have been made over the last decade and recently the use of neoadjuvant treatment to downsize disease followed by liver resection was demonstrated to improve patients' survival. Besides curative surgery, tumour de-bulking was shown to be of abundant benefit for patients suffering from neuroendocrine tumours (NET) with liver metastasis owing to relieve or control symptoms. Liver resection is nowadays even extended for non-CRC and non-NET metastases, depending on the clinical course of the primary disease.

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