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Artif Intell Gastroenterol. Apr 28, 2022; 3(2): 28-35
Published online Apr 28, 2022. doi: 10.35712/aig.v3.i2.28
Liver surgery for colorectal metastasis: New paths and new goals with the help of artificial intelligence
Valeria Tonini, Gabriele Vigutto, Riccardo Donati
Valeria Tonini, Department of Medical and Surgical Sciences, Sant' Orsola Hospital University of Bologna, Bologna 40138, Italy
Gabriele Vigutto, Department of Medical and Surgical Sciences, St Orsola Hospital, University of Bologna, Bologna 40138, Italy
Riccardo Donati, Department of Electrical, Electronic and Information Engineering ”Guglielmo Marconi” (DEI), University of Bologna, Bologna 40138, Italy
Author contributions: Tonini V, Vigutto G, and Donati R wrote the paper together and equally contributed to the final manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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:
Corresponding author: Valeria Tonini, MD, PhD, Professor, Surgeon, Department of Medical and Surgical Sciences, University of Bologna, Sant' Orsola Hospital, Via Massarenti 9, Bologna 40138, Italy.
Received: December 20, 2021
Peer-review started: December 21, 2021
First decision: March 12, 2022
Revised: March 28, 2022
Accepted: April 19, 2022
Article in press: April 19, 2022
Published online: April 28, 2022

Colorectal cancer is one of the most common neoplasia with an high risk to metastatic spread. Improving medical and surgical treatment is moving along with improving the precision of diagnosis and patient's assessment, the latter two aided more and more with the use of artificial intelligence (AI). The management of colorectal liver metastasis is multidisciplinary, and surgery is the main option. After the diagnosis, a surgical assessment of the patient is fundamental. Reaching a R0 resection with a proper remnant liver volume can be done using new techniques involving also artificial intelligence. Considering the recent application of artificial intelligence as a valid substitute for liver biopsy in chronic liver diseases, several authors tried to apply similar techniques to pre-operative imaging of liver metastasis. Radiomics showed good results in identifying structural changes in a unhealthy liver and in evaluating the prognosis after a liver resection. Recently deep learning has been successfully applied in estimating the remnant liver volume before surgery. Moreover AI techniques can help surgeons to perform an early diagnosis of neoplastic relapse or a better differentiation between a colorectal metastasis and a benign lesion. AI could be applied also in the histopathological diagnostic tool. Although AI implementation is still partially automatized, it appears faster and more precise than the usual diagnostic tools and, in the short future, could become the new gold standard in liver surgery.

Keywords: Colo-rectal cancer, Liver metastasis, Artificial intelligence, Radiomics, Deep learning

Core Tip: Colon cancer is one of the most frequent cancers that unfortunately has a high risk of metastatic spread especially to the liver. The treatment of liver metastases is multidisciplinary, but surgery remains undoubtedly the main act. The results in the treatment of liver metastases have improved significantly over the years, but we continue to seek further paths of improvement. A new path, to which we currently entrust many hopes, is that of artificial intelligence, which could bring revolutionary solutions both in the diagnosis of liver metastases, and as a useful guide for surgical techniques. The purpose of this article is to summarize the latest news reported in the literature and possible research developments on this topic.