Journal of Gastrointestinal Surgery

, Volume 11, Issue 7, pp 929–944 | Cite as

Detection and Management of Extrahepatic Colorectal Cancer in Patients with Resectable Liver Metastases

  • Yolanda Y. L. Yang
  • James W. Fleshman
  • Steven M. Strasberg
Article

Abstract

The presence of extrahepatic disease has a great effect on the management of patients with metastatic colorectal cancer in the liver. FDG-PET scanning is currently the most sensitive way of detecting extrahepatic metastases in such patients. This is supported by 10 studies, which show that FDG-PET scan will discover extrahepatic disease in about one in six patients who have completed standard imaging. Staging laparoscopy is another means of detecting extrahepatic disease. Its role remains undefined especially in patients who have had FDG-PET scans. It should probably be restricted to patients with high clinical risk scores. In terms of treatment, patients with recurrence at the primary colorectal site as well as resectable liver metastases appear to benefit from resection of both sites provided that R0 resections can be obtained. Resection of involved hepatic pedicle lymph nodes in patients with resectable liver metastases is associated with poor outcome. The situation regarding patients with peritoneal and liver metastases bears a strong resemblance to that of primary site recurrence and liver metastases. Very acceptable survival can be expected if the peritoneal disease can be eradicated. Information regarding treatment of lung and liver metastases is the most complete of any of these areas. Good results may be expected if all the disease can be cleared. Caution is required in interpreting claims of good survival when study numbers are small and confidence intervals of data are not provided.

Keywords

Extrahepatic colorectal cancer Colorectal cancer Liver metastasis Liver resection FDG-PET scan Colorectal lung metastases Colorectal peritoneal metastases Colorectal portal lymph node metastases 

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Yolanda Y. L. Yang
    • 1
  • James W. Fleshman
    • 2
  • Steven M. Strasberg
    • 3
  1. 1.The Permanente Medical GroupKaiser, South San FranciscoSan FranciscoUSA
  2. 2.Section of Colorectal SurgeryWashington University in St. Louis and Siteman Cancer CenterSt. LouisUSA
  3. 3.Section of Hepatobiliary-Pancreatic SurgeryWashington University in Saint Louis and Siteman Cancer CenterSt. LouisUSA

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