Skip to main content


Weitere Artikel dieser Ausgabe durch Wischen aufrufen

22.05.2018 | main topic | Ausgabe 3/2018

European Surgery 3/2018

Patient selection and perioperative optimisation in surgery for colorectal liver metastases

European Surgery > Ausgabe 3/2018
BMBS Dr. Benjamin D Jones, PhD FRCS Robert Jones, FRCS Declan FJ Dunne, MBChB MRCP FRCA FFICM Tim Astles, FRCS Stephen W Fenwick, MS Graeme J Poston, FRCS Hassan Z Malik



Clinical decision-making around the management of liver-limited stage IV colorectal cancer involves careful assessment of the potential risks and benefits of surgery. This balance can often be optimised through appropriate patient selection to ensure long-term benefit of any operation, with fastidious perioperative care to minimize risk.


We reviewed selected relevant articles from the existing literature.


Multi-platform imaging is routinely used to determine distribution of disease and whether lesions are technically resectable, but what remains less clear is how to identify patients in whom resection is likely to deliver long-term benefits. A number of prognostic markers have been identified, with growing interest in direct assessment of tumour biology; genotyping of RAS status is routine in specific situations. Following a multidisciplinary team decision to proceed to surgery, patients undergo perioperative assessment and optimisation. Cardiopulmonary exercise testing helps to stratify perioperative risk: patients with low uptake of oxygen at the anaerobic threshold are known to have worse perioperative outcomes, and prehabilitation may offer the chance to reduce this risk. Intraoperative anaesthetic management is on a patient-by-patient basis but sub-normal hydration, epidural anaesthesia and steroids play a key role. Enhanced recovery after surgery programmes have improved perioperative outcomes while providing a potential economic benefit.


Despite very good perioperative results, surgical management is not curative for the majority of patients, highlighting the need to further refine patient selection and definition of treatment aim on a patient-by-patient basis.

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Sie möchten Zugang zu diesem Inhalt erhalten? Dann informieren Sie sich jetzt über unsere Produkte:

Abo für kostenpflichtige Inhalte

Über diesen Artikel

Weitere Artikel der Ausgabe 3/2018

European Surgery 3/2018 Zur Ausgabe