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Molecular Determinants and Other Factors to Guide Selection of Patients for Hepatic Resection of Metastatic Colorectal Cancer

  • Lower Gastrointestinal Cancers (AB Benson, Section Editor)
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Opinion statement

Treatment for metastatic colorectal cancer (CRC) has changed significantly over the last few decades as cytotoxic and targeted chemotherapies have evolved and resection of (technically feasible) colorectal liver metastases (CRLM) has become standard of care for eligible patients. Overall, survival for metastatic CRC has considerably improved, but recurrences are common. Numerous clinical risk scores have been suggested to guide patient selection for CRLM resection, but none perfectly predict outcomes; therefore, a personalized approach to metastatic CRC treatment using genetic profiles for risk stratification and prognostication is a critically important advancement. All patients with suspected metastatic CRC should undergo genetic testing for common oncogene mutations (e.g., KRAS, BRAF, and NRAS) in addition to a triphasic CT scan of the chest, abdomen, and pelvis; if hepatectomy may be entertained and there is concern about the future liver remnant (FLR), liver volumetrics should also be performed. MRI and PET are useful adjuncts for cases in which diagnosis or extent of disease is unclear. The decision to operate should be individualized and based on each patient’s condition, tumor biology, and technical resectability. Genetic profiles should be used to inform multidisciplinary meetings surrounding topics of chemotherapy and surgical resection, as well as patient discussions concerning the risks and benefits of surgery. In the end, most patients with technically resectable colorectal cancers and adequate cardiopulmonary fitness benefit from surgical resection, as it remains the only chance of long-term survival.

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Acknowledgements

Research reported in this publication was supported by the National Cancer Institute and Fogarty International Center and National Institute of Mental Health of the National Institutes of Health under Award Numbers T32CA090217 and D43TW010543. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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  1. Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA

    Thomas M. Diehl MD

  2. Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, Wisconsin, USA

    Daniel E. Abbott MD, FACS

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Diehl, T.M., Abbott, D.E. Molecular Determinants and Other Factors to Guide Selection of Patients for Hepatic Resection of Metastatic Colorectal Cancer. Curr. Treat. Options in Oncol. 22, 82 (2021). https://doi.org/10.1007/s11864-021-00878-5

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