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Synchronous Colorectal Liver Metastases: Is It Time to Reconsider Traditional Paradigms of Management?

  • Controversies in the Management of Hepatic Colorectal Metastases
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients with synchronous colorectal liver metastases (CLM) are typically treated with initial colorectal resection followed by arbitrary and prolonged courses of chemotherapy. Partial hepatectomy is considered only for patients without interval disease progression. This review describes the rationale for this treatment approach and the recent developments suggesting that this management paradigm should be reconsidered.

Results

Because asymptomatic colorectal cancer often does not lead to complications, and given the potential benefit of chemotherapy in downsizing unresectable to resectable liver disease, most patients with asymptomatic primary tumors and unresectable synchronous CLM should be first treated with chemotherapy. In contrast, initial hepatic resection should be considered for resectable synchronous CLM. Survival benefits from prehepatectomy chemotherapy have not been established. Several reports demonstrate morbidity after hepatic resection from extended durations of irinotecan- and/or oxaliplatin-based prehepatectomy chemotherapy. Although shorter treatment periods may not have these deleterious effects on subsequent hepatic resection, prospective studies reveal that most patients with supposedly aggressive disease with short treatment durations will not be identified. Moreover, a complete radiologic response to prehepatectomy chemotherapy is not only rare but also does not equate with a complete pathological response. Finally, several studies suggest that simultaneous colorectal and minor hepatic resections can performed safely with benefits in total morbidity when compared with traditional staged procedures.

Conclusions

The traditional treatment paradigm centering on the utility of prehepatectomy chemotherapy for resectable synchronous CLM should be reconsidered. Recent developments underscore the need for prospective randomized controlled trials evaluating the optimal timing of hepatectomy relative to chemotherapy.

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References

  1. Chafai N, Chan CLH, Bokey EL, et al. What factors influence survival in patients with unresected synchronous liver metastases after resection of colorectal cancer? Colorectal Dis. 2005;7:176–81.

    Article  PubMed  CAS  Google Scholar 

  2. Rougier P, Milan C, Lazorthes F, et al. Prospective study of prognostic factors in patients with unresected hepatic metastases from colorectal cancer. Br J Surg. 1995;82:1397–400.

    Article  PubMed  CAS  Google Scholar 

  3. Stangl R, Altendorf-Hofmann A, Charnley RM, et al. Factors influencing the natural history of colorectal liver metastases. Lancet. 1994;343:1405–10.

    Article  PubMed  CAS  Google Scholar 

  4. Al-asfoor A, Fedorowicz Z, Lodge M. Resection versus no intervention or other surgical interventions for colorectal liver metastases. Cochrane Database Syst Rev. 2008;CD006039.

  5. Cummings FJ, Varker K, Begossi G, et al. Hepatic artery infusion in surgical therapy of hepatic metastases from colorectal cancer. J Clin Oncol. 2008;26:abstr 15077.

    Google Scholar 

  6. Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2008;25:4575–80.

    Article  Google Scholar 

  7. Newland RC, Dent OF, Chapuis PH, et al. Clinicopathologically diagnosed residual tumour after resection for colorectal cancer: a 20-year prospective study. Cancer. 1993;72:1536–42.

    Article  PubMed  CAS  Google Scholar 

  8. Vigano L, Ferrero A, Tesoriere RL, et al. 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;15:2458–64.

    Article  PubMed  Google Scholar 

  9. Pawlik TM, Scoggins CR, Zorzi D, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection of colorectal metastases. Ann Surg. 2005;241:715–24.

    Article  PubMed  Google Scholar 

  10. Portier G, Elias D, Bouche O, et al. Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases: FFCD ACHBTH AURC 9002 Trial. J Clin Oncol. 2006;24:4976–82.

    Article  PubMed  CAS  Google Scholar 

  11. Aloia TA, Vauthey JN, Loyer EM, et al. Solitary colorectal liver metastasis: resection determined outcome. Arch Surg. 2006;141:460–6.

    Article  PubMed  Google Scholar 

  12. Charnsangavej C, Clary B, Fong Y, et al. Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol. 2006;13:1261–8.

    Article  PubMed  Google Scholar 

  13. Pawlik TM, Schulick RD, Choti MA. Expanding criteria for resectability of colorectal liver metastases. Oncologist. 2008;13:51–64.

    Article  PubMed  Google Scholar 

  14. Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy. Ann Surg. 2004;240:644–58.

    Article  PubMed  Google Scholar 

  15. Fortner JG, Silva JS, Cox EB, et al. Multivariate of a personal series of 247 patients with liver metastases from colorectal cancer. Ann Surg. 1984;199:317–24.

    PubMed  CAS  Google Scholar 

  16. Yamamura T, Senda T, Akaishi O, et al. Comparative studies on treatment for liver metastases from colorectal cancer. St Marianna Med J. 1990;18:501–8.

    Google Scholar 

  17. Cady D, Monson DO, Swinton NW. Survival of patients after colonic resection for carcinoma with simultaneous liver metastases. Surg Gynecol Obstet. 1970;131:697–700.

    PubMed  CAS  Google Scholar 

  18. Blumgart LH, Allison DJ. Resection and embolization in the management of secondary hepatic tumors. World J Surg. 1982;6:32–45.

    Article  PubMed  CAS  Google Scholar 

  19. Jatzko G, Wette V, Muller M, et al. Simultaneous resection of colorectal carcinoma and synchronous liver metastases in a district hospital. Int J Colorectal Dis. 1991;6:111–4.

    Article  PubMed  CAS  Google Scholar 

  20. Minagawa M, Yamamoto J, Miwa S, et al. Selection criteria for simultaneous resection in patients with synchronous liver metastasis. Arch Surg. 2006;141:1006–12.

    Article  PubMed  Google Scholar 

  21. Tebutt NC, Norman AR, Cunningham D, et al. Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases. Gut. 2003;52:568–73.

    Article  Google Scholar 

  22. Scoggins CR, Meszoely IM, Blanke CD, et al. Nonoperative management of primary colorectal cancer in patients with stage IV disease. J Surg Oncol. 1999;6:651–7.

    Article  CAS  Google Scholar 

  23. Benoist S, Pautrat K, Mitry E, et al. Treatment strategy for patients with colorectal cancer and synchronous irresectable liver metastases. Br J Surg. 2005;92:1155–60.

    Article  PubMed  CAS  Google Scholar 

  24. Tournigand C, Andre T, Achille E, et al. FOLFIRI followed by FOLFOX or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol. 2004;22:229–37.

    Article  PubMed  CAS  Google Scholar 

  25. Hurwitz H, Fehrenbacher L, Novotny W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350:2335–42.

    Article  PubMed  CAS  Google Scholar 

  26. Meyerhardt JA, Mayer RJ. Systemic therapy for colorectal cancer. N Engl J Med. 2005;352:476–87.

    Article  PubMed  CAS  Google Scholar 

  27. Rivera F, Van Cutsem E, Kretzschmar A, et al. Preliminary efficacy of bevacizumab with first-line FOLFOX, XELOX, FOLFIRI, and monotherapy for mCRC: first BEATrial. Ann Oncol. 2007;18:abstr O-0025.

  28. Tirelli U, Berretta M, Di Benedetto F, et al. Presurgical chemotherapy with FOLFOX4-regimen for patients with unresectable liver metastases from colorectal cancer. J Clin Oncol. 2008;26:abstr 15052.

    Google Scholar 

  29. Masi G, Loupakis F, Baldi G, et al. Outcome of initially unresectable metastatic colorectal cancer patients treated with first-line FOLFOXIRI followed by R0 surgical resection of metastases. J Clin Oncol. 2008;26:abstr 4074.

    Google Scholar 

  30. Wicherts DA, de Haas RJ, Adam R. Bringing unresectable liver disease to resection with curative intent. Eur J Surg Oncol. 2007;33:S42–51.

    PubMed  Google Scholar 

  31. Pozzo C, Basso M, Cassano A, et al. Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients. Ann Oncol. 2004;15:933–9.

    Article  PubMed  CAS  Google Scholar 

  32. Nuzzo G, Giuliante F, Ardito F, et al. Liver resection for primary unresectable colorectal metastases downsized by chemotherapy. J Gastrointest Surg. 2007;11:318–24.

    Article  PubMed  Google Scholar 

  33. Abdalla EK, Adam R, Bilchik AJ, et al. Improving resectablity of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol. 2006;13:1271–80.

    Article  PubMed  Google Scholar 

  34. Nordlinger B, Van Cutsem E, Rougier P, et al. Does chemotherapy prior to liver resection increase the potential for cure in patients with metastatic colorectal cancer? Eur J Cancer. 2007;43:2037–45.

    Article  PubMed  CAS  Google Scholar 

  35. Adam R, Wicherts DA, de Haas RJ, et al. Patients with initially irresectable colorectal liver metastases: is there a possibility of cure by an oncosurgical approach? J Clin Oncol. 2008;26:abstr 4081.

    Google Scholar 

  36. Adam R, Aloia T, Levi F, et al. Hepatic resection after rescue cetuximab treatment for colorectal liver metastases previously refractory to conventional systemic therapy. J Clin Oncol. 2007;25:4593–602.

    Article  PubMed  CAS  Google Scholar 

  37. Wagner AD, Arnold D, Grothey A, et al. Anti-angiogenic therapies for metastatic colorectal cancer: preliminary results of a systematic review and meta-analysis. J Clin Oncol. 2008;26:abstr 4060.

    Google Scholar 

  38. Hochster HS, Hart LL, Ramanathan RK, et al. Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: results of the TREE study. J Clin Oncol. 2008;26:3523–9.

    Article  PubMed  CAS  Google Scholar 

  39. Minagawa M, Yamamoto J, Kosuge T, et al. Simplified staging system for predicting the prognosis of patients with resectable liver metastasis: development and validation. Arch Surg. 2007;142:269–76.

    Article  PubMed  Google Scholar 

  40. Minagawa M, Makuuchi M, Torzilli G, et al. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg. 2000;231:487–99.

    Article  PubMed  CAS  Google Scholar 

  41. Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–21.

    Article  PubMed  CAS  Google Scholar 

  42. Nordlinger B, Guiguet M, Vaillant JC, 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;77:1254–62.

    Article  PubMed  CAS  Google Scholar 

  43. Schindl M, Wigmore SJ, Currie EJ, et al. Prognostic scoring in colorectal cancer liver metastasis: development and validation. Arch Surg. 2005;140:183–9.

    Article  PubMed  Google Scholar 

  44. Altendorf-Hofmann A, Scheele J. A critical review of the major indicators of prognosis after resection of hepatic metastases form colorectal carcinoma. Surg Oncol Clin N Am. 2003;12:165–92.

    Article  PubMed  Google Scholar 

  45. Mala T, Bohler G, Mathisen O, et al. Hepatic resection for colorectal metastases: can preoperative scoring predict outcome? World J Surg. 2002;26:1348–53.

    Article  PubMed  Google Scholar 

  46. van Ooijen B, Wiggers T, Meijer S, et al. Hepatic resections for colorectal metastases in The Netherlands: a multi-institutional 10-year study. Cancer. 1992;70:28–34.

    Article  PubMed  Google Scholar 

  47. Cady B, Jenkins RL, Steele GD, et al. Surgical margin in hepatic resection for colorectal metastases: a critical and improvable determinant of outcome. Ann Surg. 1998;227:566–71.

    Article  PubMed  CAS  Google Scholar 

  48. Jamison RL, Donohue JH, Nagorney DM, et al. Hepatic resection for metastatic colorectal cancer results in cure for some patients. Arch Surg. 1997;132:505–11.

    PubMed  CAS  Google Scholar 

  49. Hughes K, Scheele J, Sugarbaker PH. Surgery for colorectal cancer metastatic to the liver: optimizing the results of treatment. Surg Clin N Am. 1989;69:339–59.

    PubMed  CAS  Google Scholar 

  50. Hughes KS, Rosenstein RB, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of long-term survivors. Dis Colon Rectum. 1988;31:1–4.

    Article  PubMed  CAS  Google Scholar 

  51. Jenkins LT, Millikan KW, Bines SD, et al. Hepatic resection for metastatic colorectal cancer. Am Surg. 1997;63:605–10.

    PubMed  CAS  Google Scholar 

  52. Doci R, Gennari L, Bignami P, et al. One hundred patients with hepatic metastases from colorectal cancer treated by resection: analysis of prognostic determinants. Br J Surg. 1991;78:797–801.

    Article  PubMed  CAS  Google Scholar 

  53. Hohenberger P, Schlag PM, Gerneth T, et al. Pre- and postoperative carcinoembryonic antigen determinations in hepatic resection for colorectal metastases: predictive value and implications for adjuvant treatment based on multivariate analysis. Ann Surg. 1994;219:135–43.

    Article  PubMed  CAS  Google Scholar 

  54. Ychou M, Hohenberger W, Thezenas S, et al. Randomized phase III trial comparing infused 5-fluorouracil/folinic acid (LV5FU) versus LV5FU + irinotecan (LV5FU + IRI) as adjuvant treatment after complete resection of liver metastases from colorectal cancer (LMCRC). J Clin Oncol. 2008;26:abstr LBA4013.

  55. Mariani P, Des Guetz G, Uzzan B, et al. Systemic or hepatic arterial chemotherapy after curative resection of liver metastases from colorectal cancer: a meta-analysis of randomized controlled trials. J Clin Oncol. 2008;26:abstr 4077.

  56. Iwatsuki S, Dvorchik I, Madariaga JR, et al. Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system. J Am Coll Surg. 1999;189:291–9.

    Article  PubMed  CAS  Google Scholar 

  57. Harmon KE, Ryan JA, Biehl TR, et al. Benefits and safety of hepatic resection for colorectal metastases. Am J Surg. 1999;177:402–4.

    Article  PubMed  CAS  Google Scholar 

  58. Harms J, Obst T, Thorban S, et al. The role of surgery in the treatment of liver metastases for colorectal cancer patients. Hepatogastroenterology. 1999;46:2321–8.

    PubMed  CAS  Google Scholar 

  59. Kokudo N, Seki M, Ohta H, et al. Effects of systemic and regional chemotherapy after hepatic resection for colorectal metastases. Ann Surg Oncol. 1998;5:706–12.

    Article  PubMed  CAS  Google Scholar 

  60. Bockhorn M, Frilling A, Fruhauf NR, et al. Survival of patients with synchronous and metachronous colorectal liver metastases—is there a difference? J Gastrointest Surg. 2008;12:1399–405.

    Article  PubMed  Google Scholar 

  61. Capussotti L, Vigano L, Ferrero A, et al. Timing of resection of liver metastases synchronous to colorectal tumor: proposal for prognosis-based decisional model. Ann Surg Oncol. 2007;14:1143–50.

    Article  PubMed  Google Scholar 

  62. Lee WS, MJ Kim, SH Yun, et al. Risk factor stratification after simultaneous liver and colorectal resection for synchronous colorectal metastasis. Langenbecks Arch Surg. 2008;393:13–9.

    Article  PubMed  Google Scholar 

  63. de Santibanes E, Lassalle FB, McCormack L, et al. Simultaneous colorectal and hepatic resections for colorectal cancer: postoperative and longterm outcomes. J Am Coll Surg. 2002;195:196–202.

    Article  PubMed  Google Scholar 

  64. Gruenberger T, Kaczirek K, Bergmann M, et al. Progression-free survival in a phase II study of perioperative bevacizumab plus XELOX in patients with potentially curable metastatic colorectal cancer. J Clin Oncol. 2008;26:abstr 4073.

    Google Scholar 

  65. Jonas S, Thelen A, Benckert C, et al. Extended resections of liver metastases from colorectal cancer. World J Surg. 2007;31:511–21.

    Article  PubMed  CAS  Google Scholar 

  66. 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;50:478–88.

    Article  PubMed  Google Scholar 

  67. Tsai MS, Su YH, Ho MC, et al. Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastasis. Ann Surg Oncol. 2007;14:786–94.

    Article  PubMed  Google Scholar 

  68. Wei AC, Greig PD, Grant D, et al. Survival after hepatic resection for colorectal metastases: a 10-year experience. Ann Surg Oncol. 2006;13:668–76.

    Article  PubMed  Google Scholar 

  69. Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2002;235:759–66.

    Article  PubMed  Google Scholar 

  70. Malik HZ, Hamady ZZR, Adair R, et al. Prognositic influence of multiple hepatic metastases from colorectal cancer. Eur J Surg Oncol. 2007;33:468–73.

    Article  PubMed  CAS  Google Scholar 

  71. Ercolani G, Grazi GL, Ravaioli M, et al. Liver resection for multiple colorectal metastases: influence of parenchymal involvement and total tumor volume, vs. number or location, on long-term survival. Arch Surg. 2002;137:1187–92.

    Article  PubMed  Google Scholar 

  72. Bakalakos EA, Kim JA, Young DC, et al. Determinants of survival following hepatic resection for metastatic colorectal cancer. World J Surg. 1998;22:399–405.

    Article  PubMed  CAS  Google Scholar 

  73. Ohlsson B, Stenram U, Tranberg KG. Resection of colorectal liver metastases: 25-year experience. World J Surg. 1998;22:268–77.

    Article  PubMed  CAS  Google Scholar 

  74. Ambiru S, Miyazaki M, Isono T, et al. Hepatic resection for colorectal metastases: analysis of prognostic factors. Dis Colon Rectum. 1999;42:632–9.

    Article  PubMed  CAS  Google Scholar 

  75. Laurent C, Cunha AS, Couderc P, et al. Influence of postoperative morbidity on long-term survival following liver resection for colorectal metastases. Br J Surg. 2003;90:1131–6.

    Article  PubMed  CAS  Google Scholar 

  76. Bradley AL, Chapman WC, Wright JK, et al. Surgical experience with hepatic colorectal metastasis. Am Surg. 1999;65:560–6.

    PubMed  CAS  Google Scholar 

  77. Nagashima I, Takada T, Matsuda K, et al. A new scoring system to classify patients with colorectal liver metastases: proposal of criteria to select candidates for hepatic resection. J Hepatobiliary Pancreat Surg. 2004;11:79–83.

    Article  PubMed  Google Scholar 

  78. Nicoli N, Casaril A, Mangiante G, et al. Surgical treatment for liver metastases from colorectal carcinoma: results of 228 patients. Hepatogastroenterology. 2004;51:1810–4.

    PubMed  Google Scholar 

  79. Seifert JK, Bottger TC, Weigel TF, et al. Prognostic factors following liver resection for hepatic metastases from colorectal cancer. Hepatogastroenterology. 2000;47:239–46.

    PubMed  CAS  Google Scholar 

  80. Tanaka K, Shimada H, Ueda M, et al. Long-term characteristics of 5-year survivors after liver resection for colorectal metastases. Ann Surg Oncol. 2007;14:1336–46.

    Article  PubMed  Google Scholar 

  81. Parks R, Gonen M, Kemeny N, et al. Adjuvant chemotherapy improves survival after resection of hepatic colorectal metastases: analysis of data from two continents. J Am Coll Surg. 2007;204:753–63.

    Article  PubMed  Google Scholar 

  82. Nordlinger B, Sorbye H, Glemelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for respectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomized controlled trial. Lancet. 2008;371:1007–16.

    Article  PubMed  CAS  Google Scholar 

  83. Gruenberger B, Scheithauer, Punzengruber R, et al. Importance of response to neoadjuvant chemotherapy in potentially curable colorectal cancer liver metastases. BMC Cancer. 2008;8:120–7.

    Article  PubMed  CAS  Google Scholar 

  84. Taylor I. Adjuvant chemotherapy after resection of liver metastases from colorectal cancer. Eur J Cancer. 2008;44:1198–201.

    Article  PubMed  CAS  Google Scholar 

  85. Tanaka K, Adam R, Shimada H, et al. Role of neoadjuvant chemotherapy in the treatment of multiple colorectal metastases to the liver. Br J Surg. 2003;90:963–9.

    Article  PubMed  CAS  Google Scholar 

  86. Hewes JC, Dighe S, Morris RW, et al. Preoperative chemotherapy and the outcome of liver resection for colorectal metastases. World J Surg. 2007;31:353–64.

    Article  PubMed  CAS  Google Scholar 

  87. Allen PJ, Kemeny N, Jarnagin W, et al. Importance of neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases. J Gastrointest Surg. 2003;7:109–15.

    Article  PubMed  Google Scholar 

  88. Mentha G, Majno P, Terraz S, et al. Treatment strategies for the management of advanced colorectal liver metastases detected synchronously with the primary tumour. Eur J Surg Oncol. 2007;33:S76–83.

    PubMed  Google Scholar 

  89. Mentha G, Majno PE, Andres A, et al. Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg. 2006;93:872–8.

    Article  PubMed  CAS  Google Scholar 

  90. Kornprat P, Jarnagin WR, Gonen M, et al. Outcome after hepatectomy for multiple (four or more) colorectal metastases in the era of effective chemotherapy. Ann Surg Oncol. 2007;14:1151–60.

    Article  PubMed  Google Scholar 

  91. Adam R, Pascal G, Castaing D, et al. Tumor progression while on chemotherapy. Ann Surg. 2004;240:1052–64.

    Article  PubMed  Google Scholar 

  92. Lambert LA, Colacchio TA, Barth RJ. Interval hepatic resection of colorectal metastases improves patient selection. Arch Surg. 2000;135:473–9.

    Article  PubMed  CAS  Google Scholar 

  93. Yoshidome H, Kimura F, Shimizu H, et al. Interval period tumor progression: does delayed hepatectomy detect occult metastases in synchronous colorectal liver metastases? J Gastrointest Surg. 2008;12:1391–8.

    Article  PubMed  Google Scholar 

  94. Kopetz S, Vauthey JN. Perioperative chemotherapy for resectable hepatic metastases. Lancet. 2008;371:963–4.

    Article  PubMed  Google Scholar 

  95. Shimizu Y, Yasui K, Sano T, et al. Validity of observation interval for synchronous hepatic metastases of colorectal cancer: changes in hepatic and extrahepatic metastatic foci. Langenbecks Arch Surg. 2008;393:181–4.

    Article  PubMed  Google Scholar 

  96. Gruenberger G, Tamandl D, Schueller J, et al. Bevacizumab, capecitabine, and oxaliplatin as neoadjuvant therapy for patients with potentially curable metastatic colon cancer. J Clin Oncol. 2008;26:1830–5.

    Article  PubMed  CAS  Google Scholar 

  97. Bouganim N, Ang C, Kavan P, et al. Perioperative bevacizumab containing chemotherapy for colorectal liver metastases. J Clin Oncol. 2008;26:abstr 15073.

    Google Scholar 

  98. Berry SR, Van Cutsem E, Kretzschmar A, et al. Final efficacy results for bevacizumab plus standard first-line chemotherapies in patients with metastatic colorectal cancer: first BEAT. J Clin Oncol. 2008;26:abstr 4025.

    Google Scholar 

  99. White RR, Schwartz LH, Munoz JA, et al. Assessing the optimal duration of chemotherapy in patients with colorectal liver metastases. J Surg Oncol. 2008;97:601–4.

    Article  PubMed  Google Scholar 

  100. Elias D, Youssef O, Sideris L, et al. Evolution of missing colorectal liver metastases following inductive chemotherapy and hepatectomy. J Surg Oncol. 2004;86:4–9.

    Article  PubMed  Google Scholar 

  101. Adam R, Wicherts DA, de Haas RJ, et al. Complete pathologic response after preoperative chemotherapy for colorectal liver metastases: myth or reality? J Clin Oncol. 2008;26:1635–41.

    Article  PubMed  Google Scholar 

  102. Benoit S, Brouquet A, Penna C, et al. Complete response of colorectal liver metastases after chemotherapy: does it mean cure? J Clin Oncol. 2006;24:3939–45.

    Article  Google Scholar 

  103. Tan MCB, Linehan DC, Hawkins WG, et al. Chemotherapy-induced normalization of FDG uptake by colorectal liver metastases does not usually indicate complete pathological response. J Gastrointest Surg. 2007;11:1112–9.

    Article  PubMed  Google Scholar 

  104. Covas A, Amininejad L, Lucidi V, et al. Evaluation of the correlation of complete metabolic response with 18-FDG PET scan and complete pathologic response induced by neoadjuvant chemotherapy for colorectal liver metastases. J Clin Oncol. 2008;26:abstr 4070.

  105. Conlon R, Jacobs M, Dasgupta D, et al. The value of intraoperative ultrasound during hepatic resection compared with improved preoperative magnetic resonance imaging. Eur J Ultrasound. 2003;16:211–6.

    Article  PubMed  Google Scholar 

  106. Jarnagin WR, Bach AM, Winston CB, et al. What is the yield of intraoperative ultrasonography during partial hepatectomy for malignant disease? J Am Coll Surg. 2001;192:577–83.

    Article  PubMed  CAS  Google Scholar 

  107. Wildi SM, 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;36:20–6.

    Article  PubMed  Google Scholar 

  108. Tamandl D, Herberger B, Gruenberger B, et al. Adequate preoperative staging rarely leads to a change of intraoperative strategy in patients undergoing surgery for colorectal cancer liver metastases. Surgery. 2008;143:648–57.

    Article  PubMed  Google Scholar 

  109. Rubbia-Brandt L, Audard V, Sartoretti P, et al. Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol. 2004;15:460–6.

    Article  PubMed  CAS  Google Scholar 

  110. Karoui M, Penna C, Amin-Hashem M, et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg. 2006;243:1–7.

    Article  PubMed  Google Scholar 

  111. Aloia T, Sebagh M, Plasse M, et al. Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases. J Clin Oncol. 2006;24:4983–90.

    Article  PubMed  CAS  Google Scholar 

  112. Vauthey JN, Pawlik TM, Ribero D, et al. Chemothearpy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol. 2006;24:2065–72.

    Article  PubMed  CAS  Google Scholar 

  113. Nakano H, Oussoultzoglou E, Rosso E, et al. Sinusoidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy. Ann Surg. 2008;247:118–24.

    Article  PubMed  Google Scholar 

  114. Pawlik TM, Olino K, Gleisner AL, et al. Preoperative chemotherapy for colorectal liver metastases: impact on hepatic histology and postoperative outcome. J Gastrointest Surg. 2007;11:860–8.

    Article  PubMed  Google Scholar 

  115. Kandutsch S, Klinger M, Hacker S, et al. Patterns of hepatotoxicity after chemotherapy for colorectal cancer liver metastases. Eur J Surg Oncol. 2008;34:1231–6.

    PubMed  CAS  Google Scholar 

  116. Mehta NN, Ravikumar R, Coldham CA, et al. Effect of preoperative chemotherapy on liver resection for colorectal liver metastases. Eur J Surg Oncol. 2008;34:782–6.

    PubMed  CAS  Google Scholar 

  117. Julie C, Lutz MP, Aust D, et al. Pathological analysis of hepatic injury after oxaliplatin-based neoadjuvant chemotherapy of colorectal cancer liver metastases: results of the EORTC Intergroup phase III study 40983. Paper presented at the 2007 Gastrointestinal Cancers Symposium, abstr 241.

  118. Fernandez FG, Ritter J, Goodwin JW, et al. Effect of steatohepatitis associated with irinotecan or oxaliplatin pretreatment on resectability of hepatic colorectal metastases. J Am Coll Surg. 2005;200:845–53.

    Article  PubMed  Google Scholar 

  119. Reddy SK, Morse MA, Hurwitz HI, et al. Addition of bevacizumab to irinotecan- and oxaliplatin-based preoperative chemotherapy regimens does not increase morbidity after resection of colorectal liver metastases. J Am Coll Surg. 2008;206:96–106.

    Article  PubMed  Google Scholar 

  120. Klinger M, Kandutsch S, Hacker S, et al. Patterns of hepatotoxicity after chemotherapy for colorectal cancer metastases. J Clin Oncol. 2008;226:abstr 4082.

    Google Scholar 

  121. Ribero D, Wang H, Donadon M, et al. Bevacizumab improves pathologic response and protects against hepatic injury in patients treated with oxaliplatin-based chemotherapy for colorectal liver metastases. Cancer. 2007;110:2761–7.

    Article  PubMed  Google Scholar 

  122. Aussilhou B, Faivre S, Lepille v, et al. Preoperative bevacizumab may impair liver hypertrophy of the future remnant liver after a portal vein occlusion in patients undergoing major resections of colorectal liver metastases. J Clin Oncol. 2008;26:abstr 4081.

  123. Reddy SK, Pawlik TM, Zorzi D, et al. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol. 2007;14:3481–91.

    Article  PubMed  Google Scholar 

  124. Capussotti L, Ferrero A, Vigano L, et al. Major liver resections synchronous with colorectal surgery. Ann Surg Oncol. 2007;14:195–201.

    Article  PubMed  Google Scholar 

  125. Tanaka K, Shimada H, Matsuo K, et al. Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases. Surgery. 2004;136:650–9.

    Article  PubMed  Google Scholar 

  126. Adam R. Colorectal cancer with synchronous liver metastases. Br J Surg. 2007;94:129–31.

    Article  PubMed  CAS  Google Scholar 

  127. Ariyan C, Wong D, Fong Y. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis (editorial). Ann Surg Oncol. 2007;14:3295–6.

    Article  PubMed  Google Scholar 

  128. Yan TD, Chu F, Black D, et al. Synchronous resection of colorectal primary cancer and liver metastases. World J Surg. 2007;31:1496–501.

    Article  PubMed  Google Scholar 

  129. Turrini O, Viret F, Guiramand J, et al. Strategies for the treatment of synchronous liver metastasis. Eur J Surg Oncol. 2007;33:735–40.

    PubMed  CAS  Google Scholar 

  130. Thelen A, Jonas S, Benckert C, et al. Simultaneous versus staged liver resection of synchronous liver metastases from colorectal cancer. Int J Colorectal Dis. 2007;22:1269–76.

    Article  PubMed  Google Scholar 

  131. Vassiliou I, Arkadopoulos N, Theodosopoulos T, et al. Surgical approaches of resectable synchronous colorectal liver metastases: timing considerations. World J Gastroenterol. 2007;13:1431–4.

    PubMed  Google Scholar 

  132. Weber JC, Bachellier P, Oussoultzoglou E, Jaeck D. Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg. 2003;90:956–62.

    Article  PubMed  CAS  Google Scholar 

  133. Peeters KCMJ, Marijnen CAM, Nagtegaal ID, et al. The TME trial after a median follow-up of 6 years. Ann Surg. 2007;246:693–701.

    Article  PubMed  Google Scholar 

  134. Martling A, Holm T, Johansson J, et al. The Stockholm II Trial on preoperative radiotherapy in rectal carcinoma. Cancer. 2001;92:896–902.

    Article  PubMed  CAS  Google Scholar 

  135. Folkesson J, Birgisson H, Pahlman v, et al. Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 2005;23:5644–50.

    Article  PubMed  Google Scholar 

  136. Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355:1114–23.

    Article  PubMed  CAS  Google Scholar 

  137. Ahmed S, Shahid R, Zhu T, et al. Effect of surgical resection of primary tumor in advanced colorectal cancer (CRC) on outcome: a Canadian province’s experience. J Clin Oncol. 2008;26:abstr 15016.

    Google Scholar 

  138. Ruo L, Gougoutas C, Paty PB, et al. Elective bowel resection for incurable stage IV colorectal cancer: prognostic variables for asymptomatic patients. J Am Coll Surg. 2003;196:722–8.

    Article  PubMed  Google Scholar 

  139. Michel P, Roque I, Di Fiore F, et al. Colorectal cancer with non-resectable synchronous metastases: should the primary tumor be resected? Gastroenterol Clin Biol. 2004;28:434–7.

    Article  PubMed  Google Scholar 

  140. Kemeny NE, Capanu M, Fong Y, et al. Survival after resection of liver metastases from colorectal cancer with poor clinical risk factors using adjuvant systemic plus hepatic arterial therapy. J Clin Oncol. 2008;26:abstr 4076.

    Google Scholar 

  141. Langer B, Bleiberg H, Labianca R, et al. Fluorouracil plus I-leucovorin versus observation after potentially curative resection of liver or lung metastases from colorectal cancer. Proc Am Soc Clin Oncol. 2002;21:abstr 149a.

  142. Lygidakis NJ, Sgourakis G, Vlachos L, et al. Metastatic liver disease of colorectal origin: the value of locoregional immunochemotherapy combined with systemic chemotherapy following liver resection. Results of a prospective randomized study. Hepatogastroenterology. 2001;48:1685–91.

    PubMed  CAS  Google Scholar 

  143. Lorenz M, Müller HH, Schramm H, et al. Randomized trial of surgery versus surgery followed by adjuvant hepatic arterial infusion with 5-fluorouracil and folinic acid for liver metastases of colorectal cancer. German Cooperative on Liver Metastases Arbeitsgruppe Lebermetastasen. Ann Surg. 1998;228:756–62.

    Article  PubMed  CAS  Google Scholar 

  144. Welsh FKS, Tilney HS, Tekkis PP, et al. Safe liver resection following chemotherapy for colorectal liver metastases is a matter of timing. Br J Cancer. 2007;96:1037–42.

    Article  PubMed  CAS  Google Scholar 

  145. Sahajpal A, Vollmer CM, Dixon E, et al. Chemotherapy for colorectal cancer prior to liver resection for colorectal cancer hepatic metastases does not adversely affect peri-operative outcomes. J Surg Oncol. 2007;95:22–7.

    Article  PubMed  CAS  Google Scholar 

  146. Tocchi A, Mazzoni G, Brozzetti S, et al. Hepatic resection in stage IV colorectal cancer: prognostic predictors of outcome. Int J Colorectal Dis. 2004;19:580–5.

    Article  PubMed  Google Scholar 

  147. Jaeck D, Bachellier P, Weber JC, et al. Surgical strategy in the treatment of synchronous hepatic metastases of colorectal cancers Analysis of a series of 59 operated on patients. Chirurgie. 1999;124:258–63.

    Article  PubMed  CAS  Google Scholar 

  148. Jovine E, Biolchini F, Talarico F, et al. Major hepatectomy in patients with synchronous colorectal liver metastases: whether or not a contraindication to simultaneous colorectal and liver resection? Colorectal Dis. 2007;9:245–52.

    Article  PubMed  CAS  Google Scholar 

  149. Stojanović M, Stanojević G, Radojković M, et al. Safety of simultaneous colon and liver resection for colorectal liver metastases. Vojnosanit Pregl. 2008;65:153–7.

    PubMed  Google Scholar 

  150. Zhang HZ, Dong SX, Zhou ZX, et al. Simultaneous liver and colorectal resection for synchronous colorectal liver metastasis. Zhonghua Wai Ke Za Zhi. 2007;45902–4.

  151. Taniai N, Yoshida H, Mamada Y, et al. Outcome of surgical treatment of synchronous liver metastases from colorectal cancer. J Nippon Med Sch. 2006;73:82–8.

    Article  PubMed  Google Scholar 

  152. Sasanuma H, Yasuda Y, Mortensen FV, et al. Simultaneous colorectal and liver resections for synchronous colorectal metastases. Scand J Surg. 2006;95:176–9.

    PubMed  CAS  Google Scholar 

  153. Chua HK, Sondenaa K, Tsiotos GG, et al. Concurrent vs. staged colectomy and hepatectomy for primary colorectal cancer with synchronous hepatic metastases. Dis Colon Rectum. 2004;47:1310–6.

    Article  PubMed  Google Scholar 

  154. Martin R, Paty P, Fong Y, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastases. J Am Coll Surg. 2003;197:233–42.

    Article  PubMed  Google Scholar 

  155. Lyass S, Zamir G, Matot I, et al. Combined colon and hepatic resection for synchronous colorectal liver metastases. J Surg Oncol. 2001;78:17–21.

    Article  PubMed  CAS  Google Scholar 

  156. Fujita S, Akasu T, Moriya Y. Resection of synchronous liver metastases from colorectal cancer. Jpn J Clin Oncol. 2000;30:7–11.

    Article  PubMed  CAS  Google Scholar 

  157. Sugawara Y, Yamamoto J, Yamasaki S, et al. Estimating the prognosis of hepatic resection in patients with metastatic liver tumors from colorectal cancer with special concern for the timing of hepatectomy. Surgery. 2001;129:408–13.

    PubMed  CAS  Google Scholar 

  158. Bolton JS, Fuhrman GM. Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma. Ann Surg. 2000;231:743–51.

    Article  PubMed  CAS  Google Scholar 

  159. Doko M, Zovak M, Ledinsky M, et al. Safety of simultaneous resections of colorectal cancer and liver metastases. Coll Antropol. 2000;24:381–90.

    PubMed  CAS  Google Scholar 

  160. Scheele J, Stangl R, Altendorf-Hofmann A, et al. Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery. 1991;110:13–29.

    PubMed  CAS  Google Scholar 

  161. Vogt P, Raab R, Ringe B, Pichlmayr R. Resection of synchronous liver metastases from colorectal cancer. World J Surg. 1991;15:62–7.

    Article  PubMed  CAS  Google Scholar 

  162. Jatzko G, Wette V, Muller M, et al. Simultaneous resection of colorectal carcinoma and synchronous liver metastases in a district hospital. Int J Colorect Dis. 1991;6:111–4.

    Article  CAS  Google Scholar 

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  1. Department of Surgery, Duke University Medical Center, Box 3247, Durham, NC, USA

    Srinevas K. Reddy MD, Andrew S. Barbas MD & Bryan M. Clary MD

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Correspondence to Srinevas K. Reddy MD.

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Reddy, S.K., Barbas, A.S. & Clary, B.M. Synchronous Colorectal Liver Metastases: Is It Time to Reconsider Traditional Paradigms of Management?. Ann Surg Oncol 16, 2395–2410 (2009). https://doi.org/10.1245/s10434-009-0372-1

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