Published online Aug 28, 2016. doi: 10.3748/wjg.v22.i32.7215
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.
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.