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World J Gastroenterol. May 28, 2014; 20(20): 6113-6122
Published online May 28, 2014. doi: 10.3748/wjg.v20.i20.6113
Role of surgery in colorectal cancer liver metastases
Özgür Akgül, Erdinç Çetinkaya, Şiyar Ersöz, Mesut Tez
Özgür Akgül, Şiyar Ersöz, Mesut Tez, ErdinçÇetinkaya, Department of General Surgery, Ankara Numune Education and Research Hospital, 06100 Ankara, Turkey
Author contributions: Akgül Ö drafted the manuscript and approved the final manuscript; Çetinkaya E evaluated the English language of the paper and approved the final manuscript; Ersöz Ş helped with the literature search and approved the final manuscript; Tez M critically reviewed the manuscript, and approved the final manuscript.
Correspondence to: Mesut Tez, MD, Department of General Surgery, Ankara Numune Education and Research Hospital, Samanpazarı, 5.cadde 10/3 Bahçelievler, 06100 Ankara, Turkey. mesuttez@yahoo.com
Telephone: +90-312-5084052 Fax: +90-312-5084052
Received: October 28, 2013
Revised: December 26, 2013
Accepted: February 16, 2014
Published online: May 28, 2014
Abstract

Colorectal carcinoma (CRC) is the third most common cancer, and approximately 35%-55% of patients with CRC will develop hepatic metastases during the course of their disease. Surgical resection represents the only chance of long-term survival. The goal of surgery should be to resect all metastases with negative histological margins while preserving sufficient functional hepatic parenchyma. Although resection remains the only chance of long-term survival, management strategies should be tailored for each case. For patients with extensive metastatic disease who would otherwise be unresectable, the combination of advances in medical therapy, such as systemic chemotherapy (CTX), and the improvement in surgical techniques for metastatic disease, have enhanced prognosis with prolongation of the median survival rate and cure. The use of portal vein embolization and preoperative CTX may also increase the number of patients suitable for surgical treatment. Despite current treatment options, many patients still experience a recurrence after hepatic resection. More active systemic CTX agents are being used increasingly as adjuvant therapy either before or after surgery. Local tumor ablative therapies, such as microwave coagulation therapy and radiofrequency ablation therapy, should be considered as an adjunct to hepatic resection, in which resection cannot deal with all of the tumor lesions. Formulation of an individualized plan, which combines surgery with systemic CTX, is a necessary task of the multidisciplinary team. The aim of this paper is to discuss different approaches for patients that are treated due to CRC liver metastasis.

Keywords: Colorectal cancer, Metastasis, Liver, Prognosis

Core tip: In patients with colorectal liver metastases, surgical resection is the treatment of choice. This paper aimed to discuss the goals of surgery, which should be to resect all metastases with negative histological margins while preserving sufficient functional hepatic parenchyma. The paper also discusses treatment options for patients with extensive metastatic disease who would otherwise be unresectable, such as systemic chemotherapy, radiofrequency ablation and preoperative portal vein embolization combined with surgery.