Skip to main content
SpringerLink
Log in

Bowel First? Simultaneous Resection? Liver First? Treatment options in patients with colorectal cancer and resectable synchronous liver metastases

  • Short Review
  • Published:
memo - Magazine of European Medical Oncology Aims and scope Submit manuscript

Summary

In patients with colorectal liver metastases surgical resection is the only potentially curative therapy option, with reported 5-year-survival of up to 50%. Approximately 25% of all patients with colorectal cancer have synchronous liver metastases, which has been associated with extremely poor prognosis. Advances in hepatic surgery and improved response rates to modern chemotherapeutic and targeted agents have changed our approach to stage IV patients from palliative therapy towards an aggressive multidisciplinary strategy in curative intention. However, the optimal treatment sequence in these patients has not been clearly defined. This short review summarizes the advantages and disadvantages of three different treatment approaches in patients with newly diagnosed colorectal cancer and resectable synchronous liver metastases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • www.aco-asso.at/manual/aktuell/kolorekt/kap_01.html

  • Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin, 58: 71–96, 2008

    Article  PubMed  Google Scholar 

  • Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer, 77: 1254–1262, 1996

    Article  PubMed  CAS  Google Scholar 

  • Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: Analysis of 1001 consecutive cases. Ann Surg, 230: 309–318, 1999

    Article  PubMed  CAS  Google Scholar 

  • Zitt M, Mühlmann G, Weiss H, et al. Assessment of risk-independent follow-up to detect asymptomatic recurrence after curative resection of colorectal cancer. Langenbecks Arch Surg, 391: 369–375, 2006

    Article  PubMed  Google Scholar 

  • Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg, 235: 759–766, 2002

    Article  PubMed  Google Scholar 

  • Abdalla EK, Vauthey JN, Ellis LM, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg, 239: 818–825, 2004

    Article  PubMed  Google Scholar 

  • Abdalla EK, Adam R, Bilchik AJ, et al. Imroving resectability of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol, 13: 1271–1280, 2006

    Article  PubMed  Google Scholar 

  • Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol, 25: 4575–4580, 2007

    Article  PubMed  Google Scholar 

  • Bolton JS, Fuhrmann GM. Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma. Ann Surg, 231: 743–751, 2000

    Article  PubMed  CAS  Google Scholar 

  • Chen J, Li Q, Wang C, et al. Simultaneous vs. staged resection for synchronous colorectal liver metastases: a metaanalysis. Int J Colorectal Dis, published online 29 July 2010

  • de Haas RJ, Adam R, Wicherts DA, et al. Comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases. Br J Surg, 97: 1279–1289, 2010

    Article  PubMed  CAS  Google Scholar 

  • Vauthey JN, Pawlik TM, Ribero D, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol, 24: 2065–2072, 2006

    Article  PubMed  CAS  Google Scholar 

  • Yan TD, Chu F, Black D, et al. Synchronous resection of colorectal primary cancer and liver metastases. World J Surg, 31: 1496–1501, 2007

    Article  PubMed  Google Scholar 

  • Chua HK, Sondenaa K, Tsiotos GG, et al. Concurrent vs. staged colectomy and hepatectomy for primary colorectal cancer with synchronous hepatic metastases. Dis Colon Rectum, 47: 1310–1316, 2004

    Article  PubMed  Google Scholar 

  • Lambert LA, Colacchio TA, Barth RJ Jr. Interval hepatic resection of colorectal metastases improves patient selection. Arch Surg, 135: 473–479, 2000

    Article  PubMed  CAS  Google Scholar 

  • 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 randomized controlled trial. Lancet, 371: 1007–1016, 2008

    Article  PubMed  CAS  Google Scholar 

  • Belghiti J, Hiramatsu K, Benoist S, et al. Seven hundred forty-seven hepatectomies in the late 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg, 191: 38–46, 2000

    Article  PubMed  CAS  Google Scholar 

  • Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary disease. Analysis of 1222 consecutive patients from a consecutive database. Ann Surg, 240: 698–710, 2004

    PubMed  Google Scholar 

  • Elias D, Detroz B, Lasser P, et al. Is simultaneous hepatectomy and intestinal anastomosis safe? Am J Surg, 169: 254–260, 1995

    Article  PubMed  CAS  Google Scholar 

  • Martin R, Paty P, Fong Y, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg, 197: 233–241, 2003

    Article  PubMed  Google Scholar 

  • Weber JC, Bachellier P, Oussoultzoglou E, et al. Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg, 90: 956–962, 2003

    Article  PubMed  CAS  Google Scholar 

  • Capusotti L, Ferrero A, Vigano L, et al. Major liver resections synchronous with colorectal surgery. Ann Surg Oncol, 14: 196–202, 2007

    Article  Google Scholar 

  • Tanaka K, Shimada H, Matsuo K, et al. Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases. Surgery, 136: 650–659, 2004

    Article  PubMed  Google Scholar 

  • Thelen A, Jonas S, Benckert C, et al. Simultaneous versus staged liver resection of synchronous liver metastases from colorectal cancer. Int J Colorectal Dis, 22: 1269–1276, 2007

    Article  PubMed  Google Scholar 

  • Reddy SK, Pawlik TM, Zorzi D, et al. Simultaneous resection of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol, 14: 3481–3491, 2007

    Article  PubMed  Google Scholar 

  • Mentha G, Majno PE, Andres A, et al. Neoadjuvant chemotherapy and resection of advanced liver metastases before treatment of the colorectal primary. Br J Surg, 93: 872–878, 2006

    Article  PubMed  CAS  Google Scholar 

  • Verhoef C, van der Pool AEM, Nuyttens JJ, et al. The "Liver-First approach" for patients with locally advanced rectal cancer and synchronous liver metastases. Dis Colon Rectum, 52: 23–30, 2009

    Article  PubMed  Google Scholar 

  • Brouquet A, Mortenson MM, Vauthey JN, Surgical strategies for synchronous colorectal liver metastases in 156 consecutive patients: classic, combined or reverse strategy? J Am Coll Surg, 210: 934–941, 2010

    Article  PubMed  Google Scholar 

  • Wichmann MW, Hüttl TP, Winter H, et al. Immunological effects of laparoscopic versus open colorectal surgery. Arch Surg, 140: 692–697, 2005

    Article  PubMed  Google Scholar 

  • Poultsides GA, Servais EL, Saltz LB, et al. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol, 27: 3379–3384, 2009

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Innsbruck, Austria

    M. Zitt

Authors
  1. M. Zitt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Zitt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zitt, M. Bowel First? Simultaneous Resection? Liver First? Treatment options in patients with colorectal cancer and resectable synchronous liver metastases. memo 4, 79–81 (2011). https://doi.org/10.1007/s12254-011-0261-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12254-011-0261-8

Keywords

Search

Navigation