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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Colorectal liver metastases: Current management and future perspectives
Jack Martin, Angelica Petrillo, Elizabeth C Smyth, Nadeem Shaida, Samir Khwaja, HK Cheow, Adam Duckworth, Paula Heister, Raaj Praseedom, Asif Jah, Anita Balakrishnan, Simon Harper, Siong Liau, Vasilis Kosmoliaptsis, Emmanuel Huguet
Jack Martin, Raaj Praseedom, Asif Jah, Anita Balakrishnan, Simon Harper, Siong Liau, Vasilis Kosmoliaptsis, Emmanuel Huguet, Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
Angelica Petrillo, Department of Precision Medicine, Division of Medical Oncology, University of Campania "L. Vanvitelli", Napoli 80131, Italy, & Medical Oncology Unit, Ospedale del Mare, 80147 Napoli Italy
Elizabeth C Smyth, Department of Oncology, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
Nadeem Shaida, Samir Khwaja, Department of Radiology, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB22 0QQ, United Kingdom
HK Cheow, Department of Nuclear Medicine, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
Adam Duckworth, Paula Heister, Department of Pathology, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
Author contributions: Martin J designed the structure of the overall manuscript and authored text in all sections; Petrillo A and Smyth EC authored text in the chemotherapy sections; Shaida N authored text in the interventional radiology sections; Khwaja S authored text in imaging sections; Cheow H authored text in the nuclear medicine section; Duckworth A and Heister P authored text in the pathology section; Praseedom R, Jah A, Balakrishnan A, Harper S, Liau S and Kosmoliaptsis V authored text in the surgery sections; Huguet E designed the structure of the overall manuscript and authored text in all sections. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All other authors have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Emmanuel Huguet, BSc, DPhil, FRCS, MBChB, Surgeon, Surgical Oncologist, University Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Center, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom. emmanuel.huguet@addenbrookes.nhs.uk
Received: February 27, 2020
Peer-review started: February 27, 2020
First decision: April 7, 2020
Revised: May 14, 2020
Accepted: August 31, 2020
Article in press: August 31, 2020
Published online: October 24, 2020
The liver is the commonest site of metastatic disease for patients with colorectal cancer, with at least 25% developing colorectal liver metastases (CRLM) during the course of their illness. The management of CRLM has evolved into a complex field requiring input from experienced members of a multi-disciplinary team involving radiology (cross sectional, nuclear medicine and interventional), Oncology, Liver surgery, Colorectal surgery, and Histopathology. Patient management is based on assessment of sophisticated clinical, radiological and biomarker information. Despite incomplete evidence in this very heterogeneous patient group, maximising resection of CRLM using all available techniques remains a key objective and provides the best chance of long-term survival and cure. To this end, liver resection is maximised by the use of downsizing chemotherapy, optimisation of liver remnant by portal vein embolization, associating liver partition and portal vein ligation for staged hepatectomy, and combining resection with ablation, in the context of improvements in the functional assessment of the future remnant liver. Liver resection may safely be carried out laparoscopically or open, and synchronously with, or before, colorectal surgery in selected patients. For unresectable patients, treatment options including systemic chemotherapy, targeted biological agents, intra-arterial infusion or bead delivered chemotherapy, tumour ablation, stereotactic radiotherapy, and selective internal radiotherapy contribute to improve survival and may convert initially unresectable patients to operability. Currently evolving areas include biomarker characterisation of tumours, the development of novel systemic agents targeting specific oncogenic pathways, and the potential re-emergence of radical surgical options such as liver transplantation.
Core Tip: The management of colorectal liver metastases is a complex evolving field requiring input from an experienced multi-disciplinary team involving radiology (cross sectional, nuclear medicine and interventional), Oncology, Liver surgery, Colorectal surgery, and Histopathology. Patient management is based on clinical, radiological and biomarker information. Despite incomplete evidence in this very heterogeneous patient group, maximising resection of colorectal liver metastases using all available techniques remains a key objective and provides the best chance of long-term survival. For unresectable patients, optimal systemic and locoregional chemotherapeutic, biological and radiotherapeutic treatments improve survival, and may convert initially unresectable patients to operability.
