Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2016; 22(32): 7215-7225
Published online Aug 28, 2016. doi: 10.3748/wjg.v22.i32.7215
Multisciplinary management of patients with liver metastasis from colorectal cancer
Kathleen De Greef, Christian Rolfo, Antonio Russo, Thiery Chapelle, Giuseppe Bronte, Francesco Passiglia, Andreia Coelho, Konstantinos Papadimitriou, Marc Peeters
Kathleen De Greef, Thiery Chapelle, Hepatobiliary, Transplant and endocrine surgery Department, Antwerp University Hospital, 2650 Edegem, Belgium
Christian Rolfo, Francesco Passiglia, Andreia Coelho, Phase I - Early Clinical Trials Unit, Oncology Department and Multidisciplinary Oncology Center Antwerp, Antwerp University Hospital, 2650 Edegem, Belgium
Antonio Russo, Giuseppe Bronte, Francesco Passiglia, Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, 90133 Palermo, Italy
Andreia Coelho, Oncology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, 5000-508 Vila Real, Portugal
Konstantinos Papadimitriou, Marc Peeters, Oncology Department and Multidisciplinary Oncology Center Antwerp, Antwerp University Hospital, 2650 Edegem, Belgium
Author contributions: De Greef K and Rolfo C wrote the manuscript; De Greef K, Rolfo C, Russo A, Chapelle T, Bronte G, Passiglia F, Coelho A, Papadimitriou K and Peeters M contributed to the content of the manuscript, revision and final manuscript approval; De Greef K, Rolfo C and Peeters M conceived the idea and manuscript format; De Greef K and Rolfo C contributed equally to this work.
Conflict-of-interest statement: The authors declare no conflict of interest for this paper.
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:
Correspondence to: Christian Rolfo, MD, PhD, Professor, Head of Phase I, Early Clinical Trials Unit, Oncology Department, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
Telephone: +32-3-8213646
Received: March 7, 2016
Peer-review started: March 8, 2016
First decision: May 12, 2016
Revised: June 21, 2016
Accepted: August 1, 2016
Article in press: August 1, 2016
Published online: August 28, 2016

Colorectal cancer (CRC) is one of the leading causes of cancer-related death. Surgery, radiotherapy and chemotherapy have been till now the main therapeutic strategies for disease control and improvement of the overall survival. Twenty-five per cent (25%) of CRC patients have clinically detectable liver metastases at the initial diagnosis and approximately 50% develop liver metastases during their disease course. Twenty-thirty per cent (20%-30%) are CRC patients with metastases confined to the liver. Some years ago various studies showed a curative potential for liver metastases resection. For this reason some authors proposed the conversion of unresectable liver metastases to resectable to achieve cure. Since those results were published, a lot of regimens have been studied for resectability potential. Better results could be obtained by the combination of chemotherapy with targeted drugs, such as anti-VEGF and anti-EGFR monoclonal antibodies. However an accurate selection for patients to treat with these regimens and to operate for liver metastases is mandatory to reduce the risk of complications. A multidisciplinary team approach represents the best way for a proper patient management. The team needs to include surgeons, oncologists, diagnostic and interventional radiologists with expertise in hepatobiliary disease, molecular pathologists, and clinical nurse specialists. This review summarizes the most important findings on surgery and systemic treatment of CRC-related liver metastases.

Keywords: Liver metastases, Colorectal cancer, Liver resection, Multidisciplinary team, Chemotherapy

Core tip: Approximately 25% of colorectal cancer patients have liver metastases at the initial diagnosis and almost half develop liver metastases later. Although unresectable liver metastases can be converted into resectable disease with the help of combination chemotherapy with targeted therapy, patients should be accurately selected. Multidisciplinary teams including health professional with expertise in hepatobiliary disease is needed to decide the best way to manage these patients’ treatment.