Synchronous Colorectal Liver Metastases: Triumph Of Prospective Randomized Trials Over Observational Bias Leads To Paradigm Shift
- Vijay P. Khatri MBChB, FACS
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“We can’t solve problems by using the same kind of thinking we used when we created them.”
The last one and a half decade has witnessed an exciting era for the management of advanced colorectal cancer, with emergence of effective combination chemotherapy, potent biologic agents, surgical techniques for safe hepatic resection and ancillary procedures such as portal vein embolization and radiofrequency ablation. Integration of these various interventions within the context of a multidisciplinary approach has fostered an aggressive stance amongst oncologists.1 This approach continues to be pushed forward with attempts to “tease out” additional patients who may become candidate for curative hepatic resection and hence alter the natural history of their disease.2
In this issue, Reddy et al comprehensively review the current evidence for outcomes in the management of synchronous colorectal liver metastases (CRLM) and inquire whether a paradigm shift is necessary.3 Let us examine ...
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- Reddy SK, Barbas AS, et al. Synchronous colorectal liver metastases: is it time to reconsider traditional paradigm of management? Ann Surg Oncol. 2009. DOI:10.1245/s10434-009-0372-1.
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- Wagman LD. Expanded criteria for surgery for liver metastases: thoughtful science or diamond mining? J Clin Oncol. 2008;26:3663-4. CrossRef
- Portier G, Elias D, Bouche O, et al. Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases: FFCD ACHBTH AURC 9002 trial. J Clin Oncol. 2006;24:4976-82. CrossRef
- Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371:1007-16. CrossRef
- Hillingso JG, Wille-Jorgensen P. Staged or simultaneous resection of synchronous liver metastases from colorectal cancer–a systematic review. Colorectal Dis. 2009;11:3-10. CrossRef
- Cady B. Basic principles in surgical oncology. Arch Surg. 1997;132:338-46.
- Synchronous Colorectal Liver Metastases: Triumph Of Prospective Randomized Trials Over Observational Bias Leads To Paradigm Shift
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Annals of Surgical Oncology
Volume 16, Issue 7 , pp 1762-1764
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- 1. University of California School of Medicine, Sacramento, CA, USA