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Surgical Management of Metastatic Colorectal Cancer

  • Surgery and Surgical Innovations in Colorectal Cancer (M Al-Kasspooles, Section Editor)
  • Published:
Current Colorectal Cancer Reports

Abstract

Purpose of Review

The surgical management of metastatic colorectal cancer (CRC) has evolved over time. Most often, the management of asymptomatic primary CRC with simultaneous liver metastases (LM) proceeds with neoadjuvant chemotherapy followed by surgical resection. Although the timing of surgical resection has remained controversial, the ability to achieve R0 resection and the importance of patient selection remain widely accepted.

Recent Findings

Preoperative novel modalities such as portal vein ligation (PVL) or portal vein embolization (PVE) have allowed for improved surgical outcomes and decreased post-surgical morbidity. Combination or hybrid management has also seen increased utility by associating ablation therapies with surgical resection. Finally, patients with significant comorbidities and surgically unresectable disease have benefited greatly from locoregional salvage therapies such as percutaneous ablation and radioembolization.

Summary

Here we will review pertinent literature associated with surgical management for resectable disease and explore newly developed locoregional salvage therapies for unresectable disease.

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Abbreviations

CRC:

Colorectal cancer

SLM:

Simultaneous liver metastasis

PVL:

Portal vein ligation

PVE:

Portal vein embolization

FLR:

Future liver remnant

ALPPS:

Associating liver partition and portal vein ligation for staged hepatectomy

HAI:

Hepatic-arterial infusion

MWA:

Microwave ablation

RFA:

Radiofrequency ablation

DEBIRI:

Irinotecan drug-eluting beads

TACE:

Trans-arterial chemoembolization

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Authors and Affiliations

  1. Department of Surgery, University of Kansas Medical Center, Kansas City, KS, 66160, USA

    Babak Mohammadian

  2. Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of Kansas Medical Center, Kansas City, KS, 66160, USA

    Clay D. King, Timothy M. Schmitt & Sean C. Kumer

  3. University of Kansas Health System, 4000 Cambridge Street, Mailstop 2005, Kansas City, KS, 66160-8501, USA

    Babak Mohammadian

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Correspondence to Babak Mohammadian.

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Mohammadian, B., King, C.D., Schmitt, T.M. et al. Surgical Management of Metastatic Colorectal Cancer. Curr Colorectal Cancer Rep 18, 39–44 (2022). https://doi.org/10.1007/s11888-022-00476-z

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