memo - Magazine of European Medical Oncology

, Volume 11, Issue 3, pp 196–198 | Cite as

My burning issues in the management of liver metastases of advanced colorectal cancer

  • Peter Tschann
  • Stephanie Rauch
  • Paolo Girotti
  • Holger Rumpold
  • Ingmar Königsrainer


Years ago liver metastases of any primary location were mostly treated by chemotherapy only and were associated with a poor prognosis. In the past few years, the surgical management of liver metastasis has received much hype because of new options in preoperative therapy and because of better (sometimes combined) interventional and surgical techniques. Many studies showed that liver metastases (LM) have an influence in long-term prognosis of metastasised diseases [1], especially in case of colorectal cancer liver metastasis (CRLM).

There are several problems in liver resections. Most frequent are postoperative infections, bleeding and bile leak, whereas an insufficient future liver remnant (IFLR) is a life-threatening central problem in liver surgery [ 2]. The future liver remnant (FLR) should not fall under 25–30% (Fig.  1) in a healthy liver. In chemotherapied or cirrhotic liver, FLR must be more than 40% [ 3]. Liver insufficiency (LI) is a clinical syndrome which fails to...


Conflict of interest

P. Tschann, S. Rauch, P. Girotti, H. Rumpold, and I. Königsrainer declare that they have no competing interests.


  1. 1.
    Liu Q, Hao L, Lou Z, Gao X, Gong H, Hong Y, Fu C, Zhang W. Survival time and prognostic factors of patients with initial noncurative colorectal liver metastases. Hepatology. 2010;52(2):715–29. Scholar
  2. 2.
    Clavien PA, Oberkofler CE, Raptis DA, Lehmann K, Rickenbacher A, El-Badry AM. What is critical for liver surgery and partial liver transplantation: size or quality? Hepatology. 2010;52(2):715–29. Scholar
  3. 3.
    Alvarez FA, Ardiles V, Sanchez Claria R, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks. J Gastrointest Surg. 2013;17:814–21.CrossRefPubMedGoogle Scholar
  4. 4.
    Martel G, Cieslak KP, Huang R, van Lienden KP, Wiggers JK, Belblidia A, Dagenais M, Lapointe R, van Gulik TM, Vandenbroucke-Menu F. Comparison of techniques for volumetric analysis of the future liver remnant: implications for major hepatic resections. HPB (Oxford). 2015;17(12):1051–7. Scholar
  5. 5.
    Hof J, Joosten HJ, Havenga K, de Jong KP. Radiofrequency ablation is beneficial in simultaneous treatment of synchronous liver metastases and primary colorectal cancer. PLoS ONE. 2018;13(3):e193385. Scholar
  6. 6.
    Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, Hess K, Curley SA. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239(6):818–25. discussion 825–7.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Petre EN, Sofocleous C. Thermal ablation in the management of colorectal cancer patients with oligometastatic liver disease. Visc Med. 2017;33:62–8.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    van Amerongen MJ, Jenniskens SFM, van den Boezem PB, Futterer JJ, de Wilt JHW. Radiofrequency ablation compared to surgical resection for curative treatment of patients with colorectal liver metastases—a meta-analysis. HPB (Oxford). 2017;19:749–56.CrossRefGoogle Scholar
  9. 9.
    Adam R, Wicherts DA, de Haas RJ, Ciacio O, Levi F, Paule B, Ducreux M, Azoulay D, Bismuth H, Castaing D. Patients with initially unresectable colorectal liver metastases: is there a possibility of cure? J Clin Oncol. 2009;27:1829–35.CrossRefPubMedGoogle Scholar
  10. 10.
    Miller CL, Taylor MS, Qadan M, Deshpande V, Worthington S, Smalley R, Collura C, Ryan DP, Allen JN, Blaszkowsky LS, Clark JW, Murphy JE, Parikh AR, Berger D, Tanabe KK, Lillemoe KD, Ferrone CR. Prognostic significance of surgical margin size after neoadjuvant FOLFOX and/or FOLFIRI for colorectal liver metastases. J Gastrointest Surg. 2017; Scholar
  11. 11.
    Donadon M, Cescon M, Cucchetti A, Cimino M, Costa G, Pesi B, Ercolani G, Pinna AD, Torzilli G. Parenchymal-sparing surgery for the surgical treatment of multiple colorectal liver metastases is a safer approach than major hepatectomy not impairing patients’ prognosis: a bi-institutional propensity score-matched analysis. Dig Surg. 2017; Scholar
  12. 12.
    Moris D, Ronnekleiv-Kelly S, Kostakis ID, Tsilimigras DI, Beal EW, Papalampros A, Dimitroulis D, Felekouras E, Pawlik TM. Operative results and oncologic outcomes of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) versus two-stage hepatectomy (TSH) in patients with unresectable colorectal liver metastases: a systematic review and meta-analysis. World J Surg. 2017; Scholar
  13. 13.
    Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H. Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg. 2000;232:777–85.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lang SA, Loss M, Benseler V, Glockzin G, Schlitt HJ. Long-term results after in-situ split (ISS) liver resection. Langenbecks Arch Surg. 2015;400(3):361–9. Scholar
  15. 15.
    Schnitzbauer AA, Lang SA, Goessmann H, Nadalin S, Baumgart J, Farkas SA, Fichtner-Feigl S, Lorf T, Goralcyk A, Horbelt R, Kroemer A, Loss M, Rummele P, Scherer MN, Padberg W, Konigsrainer A, Lang H, Obed A, Schlitt HJ. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2—staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012;255:405–14.CrossRefPubMedGoogle Scholar
  16. 16.
    Eshmuminov D, Raptis DA, Linecker M, Wirsching A, Lesurtel M, Clavien PA. Meta-analysis of associating liver partition with portal vein ligation and portal vein occlusion for two-stage hepatectomy. Br J Surg. 2016;103:1768–82.CrossRefPubMedGoogle Scholar
  17. 17.
    Pandanaboyana S, Bell R, Hidalgo E, Toogood G, Prasad KR, Bartlett A, Lodge JP. A systematic review and meta-analysis of portal vein ligation versus portal vein embolization for elective liver resection. Surgery. 2015;157(4):690–8. Scholar
  18. 18.
    Lang H, Baumgart J, Mittler J. Associating liver partition and portal vein ligation for staged hepatectomy in the treatment of colorectal liver metastases: current scenario. Dig Surg. 2018; Scholar
  19. 19.
    Zhou Z, Xu M, Lin N, Pan C, Zhou B, Zhong Y. Associating liver partition and portal vein ligation for staged hepatectomy versus conventional two-stage hepatectomy: a systematic review and meta-analysis. World J Surg Oncol. 2017;15:227.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Hackl C, Brunner SM, Schmidt KM, Schlitt HJ. Chirurgische Innovationen in der Therapie des metastasierten kolorektalen Karzinoms. Die Komplexität der Metastasenchirurgie als Beispiel für personalisierte Medizin. Chirurg. 2018;89(3):191–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General and Thoracic SurgeryAcademic Teaching Hospital FeldkirchFeldkirchAustria
  2. 2.Department of Medicine II (Gastroenterology and Oncology)Academic Teaching Hospital FeldkirchFeldkirchAustria

Personalised recommendations