ReviewSynchronous resection for colorectal liver metastases: The future
Section snippets
Background
As many as 25% of colorectal cancer patients will have liver metastasis (CRLM) at presentation and a further 20–30% will develop metachronous disease following colorectal surgery.1 Hepatectomy is feasible in 20% of cases and five year survival rates of up to 37–58% have been reported.2
When hepatic metastases are diagnosed concurrently with the primary colorectal tumour, the timing of surgical intervention remains controversial. Traditionally most centres have adopted a staged treatment with the
Arguments against synchronous resection
Traditionally patients who have simultaneous detection of hepatic metastases and primary colorectal disease were regarded as a less favourable group in terms of tumour biology, as metastasis had occurred even before diagnosis.3, 4, 5 Most surgeons have advocated resection of the primary disease first, followed by hepatic resection if the disease has remained operable in the interval time period.6
R0 resection may appear technically feasible at the time of surgery for the primary, however,
Arguments for synchronous resection
Several developments over the past few years have challenged the classical strategy of interval hepatic resection. In particular the continuing development of anaesthesia and critical care, improvements in radiological imaging and developments in hepato-biliary surgery have allowed traditional methods to be questioned.6 Increased pressures to decrease health care costs have also contributed to alternative approaches being considered. Clear disadvantages associated with staged resections include
Recommendations
We believe that there are certain situations which preclude a synchronous resection. Liver metastases found during emergency colorectal cancer resection (following obstruction, perforation or bleeding) should not be resected synchronously due to the high likelihood of peritoneal and other overt disease.25 Additionally, cases where the probability of post-operative liver insufficiency is increased (cirrhotics or patients in whom a major hepatectomy is being undertaken) should not undergo
Conflict of interest statement
None of the authors have any conflicting interests.
References (25)
- et al.
Seven hundred forty-seven hepatectomies in the late 1990s: an update to evaluate the actual risk of liver resection
J Am Coll Surg
(2000) - et al.
Simultaneous colorectal and hepatic resections for colorectal cancer: post operative and longterm outcomes
J Am Coll Surg
(2002) - et al.
Angiostatin: a novel angiogenesis inhibitor that mediates the suppression of metastases by a Lewis lung carcinoma
Cell
(1994) - et al.
Treatment strategies for the management of advanced colorectal liver metastases detected synchronously with the primary tumour
Eur J Surg Oncol
(2007) - et al.
Severe hepatic sinusoidal obstruction associated with Oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer
Ann Oncol
(2004) - et al.
Perioperative morbidity affects long-term survival in patients following liver resection for colorectal liver metastases
J Gastroenetrol Surg
(2008) CancerStats
- et al.
Improving resectability of hepatic colorectal metastase: expert consensus statement
Ann Surg Oncol
(2006) - et al.
Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma
Ann Surg
(2000) - et al.
The role of surgical resection of liver metastases in colorectal carcinoma
Semin Oncol
(1991)
Surgery for synchronous hepatic metastases of colorectal cancer
Scand J Gastroenetrol Suppl
Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis
Ann Surg Oncol
Cited by (15)
The impact of synchronous liver resection on the risk of anastomotic leakage following elective colorectal resection. A propensity score match analysis on behalf of the iCral study group
2021, European Journal of Surgical OncologyCitation Excerpt :However, the general policy of performing intermittent clamping of the hepatic pedicle is demonstrated to protect intestinal microcirculation from ischaemic sufferance [5]. Actually, even in the case of major hepatectomy, an increased anastomotic-related complications has not be reported, provided no clinical liver failure develops postoperatively [5,34]. Still, specific investigations on the argument are still lacking [3,9,11].
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2016, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth EditionRectal cancer with synchronous liver metastases: Do we have a clear direction?
2015, European Journal of Surgical OncologyCitation Excerpt :The classic staged approach that has been advocated in synchronous colorectal cancer liver metastases management consists of primary tumour resection, followed by chemotherapy and then liver surgery.52 Advocates of this approach believe that it allows assessment of the aggressiveness of the disease.53 There is evidence suggesting that synchronous colorectal and liver surgery is safe.19,54,55
Adjacent organs invasion: Multivisceral resections
2017, Extreme Hepatic Surgery and Other Strategies: Increasing Resectability in Colorectal Liver Metastases