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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2016; 22(2): 567-581
Published online Jan 14, 2016. doi: 10.3748/wjg.v22.i2.567
Preoperative selection of patients with colorectal cancer liver metastasis for hepatic resection
Rafif E Mattar, Faisal Al-alem, Eve Simoneau, Mazen Hassanain
Rafif E Mattar, Faisal Al-alem, Mazen Hassanain, Department of Surgery, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
Eve Simoneau, Department of Surgery, McGill University Health Centre, Hepatopancreaticobiliary Research Unit, Montreal, QC H4A 3J1, Canada
Mazen Hassanain, Department of Oncology, McGill University Health Center, Montreal, QC H4A 3J1, Canada
Author contributions: Mattar RE and Al-alem F did the literature review and wrote the manuscript; Hassanain M generated the idea and supervised the process; Simoneau E revised the manuscript; all authors approve the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mazen Hassanain, MBBS, FRCSC, FACS, PhD, Associate Professor of Surgery, Consultant HPB and Transplant Surgery, Department of Surgery, College of Medicine, King Saud University, PO Box 7805, Riyadh 11461, Saudi Arabia. mhassanain@ksu.edu.sa
Telephone: +966-11-4671584 Fax: +966-11-4679493
Received: April 29, 2015
Peer-review started: May 12, 2015
First decision: August 26, 2015
Revised: September 24, 2015
Accepted: November 30, 2015
Article in press: December 1, 2015
Published online: January 14, 2016
Abstract

Surgical resection of colorectal liver metastases (CRLM) has a well-documented improvement in survival. To benefit from this intervention, proper selection of patients who would be adequate surgical candidates becomes vital. A combination of imaging techniques may be utilized in the detection of the lesions. The criteria for resection are continuously evolving; currently, the requirements that need be met to undergo resection of CRLM are: the anticipation of attaining a negative margin (R0 resection), whilst maintaining an adequate functioning future liver remnant. The timing of hepatectomy in regards to resection of the primary remains controversial; before, after, or simultaneously. This depends mainly on the tumor burden and symptoms from the primary tumor. The role of chemotherapy differs according to the resectability of the liver lesion(s); no evidence of improved survival was shown in patients with resectable disease who received preoperative chemotherapy. Presence of extrahepatic disease in itself is no longer considered a reason to preclude patients from resection of their CRLM, providing limited extra-hepatic disease, although this currently is an area of active investigations. In conclusion, we review the indications, the adequate selection of patients and perioperative factors to be considered for resection of colorectal liver metastasis.

Keywords: Colorectal cancer liver metastases, Liver resection, Hepatectomy, Patient selection, Preoperative selection

Core tip: Resection of colorectal liver metastases has shown to prolong survival. Proper selection of patients who would benefit most from such a major procedure is crucial. Past contraindications are continuously being challenged. At present the only requirement is the anticipation of acquiring a negative margin and an adequate future liver remnant. Extrahepatic metastases are considered based on site and controllability. The use of preoperative chemotherapy in resectable disease remains an area of controversy. This article reviews the preoperative selection of patients for colorectal liver metastasectomy.