Cancers Metastatic to the Liver

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Key points

  • A diagnosis of liver metastases often can be established based on thorough clinical assessment, laboratory tests, and appropriate imaging. Liver biopsy is indicated only when the clinical diagnosis remains in doubt after appropriate radiological work-up and if the biopsy result will alter the management strategy.

  • The treatment plan for patients with liver metastases should be determined case-by-case in a multidisciplinary setting and in a center that performs liver resections.

  • Current principles

Incidentally detected solid liver lesions

Incidental identification of single or multiple solid liver lesions is not an uncommon scenario in general surgery practice. Clinical presentations in these cases include patients whose evaluation for a complaint discovered an unexpected liver lesion or patients with a history of malignancy being followed by surveillance imaging. The sequence of diagnostic steps depends in part on when a surgeon sees the patient. In general, assessment of patients with a newly discovered hepatic lesion,

Colorectal liver metastases

CRC is the third most commonly diagnosed cancer worldwide. Despite clinical advances in treatment, it remains the second leading cause of cancer-related death.19 The liver is the most common site of metastases in CRC, and more than half of the patients eventually develop liver metastasis during their disease course.20 Surgical resection is the treatment of choice for CRLMs, but only 20% of patients are deemed to be eligible for surgery at the time of diagnosis.21,22 It seems, however, that the

Neuroendocrine liver metastases

NETs with metastatic spread to the liver can originate in many sites throughout the body, including the thyroid, lung, and sites within the GI tract. Focusing on abdominal NETs, pancreatic islet cell tumors (pancreatic NETs [pNETs]), and bowel neuroendocrine (carcinoid) tumors represent a spectrum of disease whose first likely site of metastasis is the liver. Although functional pNETs may present with characteristic endocrinopathies based on the cell type (insulinoma, glucagonoma,

Noncolorectal non-neuroendocrine liver metastases

Although the surgical treatment of metachronous CRC is recognized as critical in obtaining long-term survival from metastatic disease, outcomes for the treatment of hepatic metastases of noncolorectal, non-NETs are less robust. This category is composed of a variety of tumor types, including breast, melanoma (cutaneous and ocular), soft tissue sarcomas, and tumors of genitourinary origin, among others, in surgical series. Fit patients with favorable disease biology, as evidenced by

When to refer and what to include?

Depending on surgeon and center experience and comfort with the management of a liver lesion or diffuse lesions, transfer to a high-volume liver surgery center may be needed. These reasons could include the need for additional interventional or diagnostic evaluation, such as radioembolization or endoscopic ultrasound with biopsy, experience with thermal ablation techniques (interventional radiology or surgery), the magnitude of hepatectomy needed (extended resection, staged hepatectomy, liver

Disclosure

The authors have nothing to disclose.

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References (57)

  • G. Martel et al.

    Comparison of techniques for volumetric analysis of the future liver remnant: implications for major hepatic resections

    HPB (Oxford)

    (2015)
  • J.-N. Vauthey et al.

    Pretreatment assessment of hepatocellular carcinoma: expert consensus statement

    HPB (Oxford)

    (2010)
  • K. Sasaki et al.

    Pre-hepatectomy carcinoembryonic antigen (CEA) levels among patients undergoing resection of colorectal liver metastases: do CEA levels still have prognostic implications?

    HPB (Oxford)

    (2016)
  • A.B. Cresswell et al.

    A diagnostic paradigm for resectable liver lesions: to biopsy or not to biopsy?

    HPB (Oxford)

    (2009)
  • R. Adam et al.

    Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus

    Cancer Treat Rev

    (2015)
  • J. Chakedis et al.

    Surgery provides long-term survival in patients with metastatic neuroendocrine tumors undergoing resection for non-hormonal symptoms

    J Gastrointest Surg

    (2019)
  • J.M. Sarmiento et al.

    Hepatic surgery for metastases from neuroendocrine tumors

    Surg Oncol Clin N Am

    (2003)
  • G. Ercolani et al.

    The role of liver resections for metastases from lung carcinoma

    HPB (Oxford)

    (2006)
  • S.K. Reddy et al.

    Resection of noncolorectal nonneuroendocrine liver metastases: a comparative analysis

    J Am Coll Surg

    (2007)
  • F. Cordera et al.

    Hepatic resection for noncolorectal, nonneuroendocrine metastases

    J Gastrointest Surg

    (2005)
  • W.T. Kassahun

    Controversies in defining prognostic relevant selection criteria that determine long-term effectiveness of liver resection for noncolorectal nonneuroendocrine liver metastasis

    Int J Surg

    (2015)
  • T.P. Robin et al.

    A contemporary update on the role of stereotactic body radiation therapy (SBRT) for liver metastases in the evolving landscape of oligometastatic disease management

    Semin Radiat Oncol

    (2018)
  • S.A. Padia

    Y90 clinical data update: cholangiocarcinoma, neuroendocrine tumor, melanoma, and breast cancer metastatic disease

    Tech Vasc Interv Radiol

    (2019)
  • A.M. Clark et al.

    Liver metastases: microenvironments and ex-vivo models

    Exp Biol Med

    (2016)
  • R. Adam et al.

    Multidisciplinary approach of liver metastases from colorectal cancer

    Ann Gastroenterol Surg

    (2019)
  • N. Tabchouri et al.

    Recurrence patterns after laparoscopic resection of colorectal liver metastases

    Surg Endosc

    (2018)
  • J. Engstrand et al.

    Colorectal cancer liver metastases - a population-based study on incidence, management and survival

    BMC Cancer

    (2018)
  • M. Pavel et al.

    ENETS consensus guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary

    Neuroendocrinology

    (2012)
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