Skip to main content

Surgical treatment of colorectal cancer metastasis

Abstract

Colorectal cancer is one of the most common solid tumors affecting people around the world. A significant proportion of patients with colorectal cancer will develop or will present with liver metastases. In some of these patients, the liver is the only site of metastatic disease. Thus, surgical treatment approaches are an appropriate and important treatment option in patients with liver-only colorectal cancer metastases. Resection of colorectal cancer liver metastases can produce long-term survival in selected patients, but the efficacy of liver resection as a solitary treatment is limited by two factors. First, a minority of patients with liver metastases have resectable disease. Second, the majority of patients who undergo successful liver resection for colorectal cancer metastases develop recurrent disease in the liver, extrahepatic sites, or both. In this paper, in addition to the results of liver resection for colorectal cancer metastases, we will review the results of thermal ablation. Each of these surgical treatment modalities can produce long-term survival in a subset of patients with liver-only colorectal cancer metastases, whereas administration of systemic or regional chemotherapy rarely results in long-term survival in these patients. While surgical treatments provide the best chance for long-term survival or, in some cases, the best palliation in patients with colorectal cancer liver metastases, it is clear that further improvements in patient outcome will require multimodality therapy regimens. Modern surgical treatment of colorectal liver metastases can be performed safely with low mortality and transfusion rates, and surgical treatment should be considered in patients with disease confined to their liver.

This is a preview of subscription content, access via your institution.

References

  1. Weiss L, Grundmann E, Torhorst J, Hartveit F, Moberg I, Eder M, Fenoglio-Preiser CM, Napier J, Horne CH, Lopez MJ: Haematogenous metastatic patterns in colonic carcinoma: An analysis of 1,541 necropsies. J Pathol 150: 195–203, 1986

    Google Scholar 

  2. Fong Y, Cohen AM, Fortner JG, Enker WE, Turnbull AD, Coit DG, Marrero AM, Prasad M, Blumgart LH, Brennan MF: Liver resection for colorectal metastases. J Clin Oncol 15: 938–946, 1997

    Google Scholar 

  3. Multiple: Resection of the liver for colorectal carcinoma metastases: A multi-institutional study of indications for resection. Registry of Hepatic Metastases Surgery 103: 278–288, 1988

  4. Wanebo HJ, Chu QD, Vezeridis MP, Soderberg C: Patient selection for hepatic resection of colorectal metastases. Arch Surg 131: 322–329, 1996

    Google Scholar 

  5. Minagawa M, Makuuchi M, Torzilli G, Takayama T, Kawasaki S, Kosuge T, Yamamoto J, Imamura H. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: Long-term results. Ann Surg 231: 487–499, 2000

    Google Scholar 

  6. Weber SM, Jarnagin WR, DeMatteo RP, Blumgart LH, Fong Y: Survival after resection of multiple hepatic colorectal metastases. Ann Surg Oncol 7: 643–650, 2000

    Google Scholar 

  7. Multiple. Meta-analysis group in cancer: Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer. J Natl Cancer Inst 88: 252–258, 1996

  8. Yanaga K, Nishizaki T, Yamamoto K, Taketomi A, Matsumata T, Takenaka K, Sugimachi K: Simplified inflow control using stapling devices for major hepatic resection. Arch Surg 131: 104–106, 1996

    Google Scholar 

  9. Ramacciato G, Balesh AM, Fornasari V: Vascular endostapler as aid to hepatic vein control during hepatic resections. Am J Surg 172: 358–362, 1996

    Google Scholar 

  10. Fong Y, Blumgart LH: Useful stapling techniques in liver surgery. J Am Coll Surg 185: 93–100, 1997

    Google Scholar 

  11. Fuhrman GM, Curley SA, Hohn DC, Roh MS: Improved survival after resection of colorectal liver metastases. Ann Surg Oncol 2: 537–541, 1995

    Google Scholar 

  12. Kinoshita H, Sakai K, Hirohashi K, Igawa S, Yamasaki O, Kubo S: Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg 10: 803–808, 1986

    Google Scholar 

  13. Makuuchi M, Thai BL, Takayasu K, Takayama T, Kosuge T, Gunven P, Yamazaki S, Hasegawa H, Ozaki H: Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: A preliminary report. Surgery 107: 521–527, 1990

    Google Scholar 

  14. Melendez J, Ferri E, Zwillman M, Fischer M, DeMatteo R, Leung D, Jarnagin W, Fong Y, Blumgart LH: Extended hepatic resection: A 6-year retrospective study of risk factors for perioperative mortality. J Am Coll Surg 192: 47–53, 2001

    Google Scholar 

  15. Vauthey JN, Chaoui A, Do KA, Bilimoria MM, Fenstermacher MJ, Charnsangavej C, Hicks M, Alsfasser G, Lauwers G, Hawkins IF, Caridi J: Standardized measurement of the future liver remnant prior to extended liver resection: Methodology and clinical associations. Surgery 127: 512–519, 2000

    Google Scholar 

  16. Abdalla EK, Barnett CC, Doherty DA, Encarnacion A, Curley SA, Vauthey JN: Extended hepatectomy in hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg (in press), 2001

  17. Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, Harihara Y, Takayama T: Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 26: 1176–1181, 1997

    Google Scholar 

  18. Azoulay D, Castaing D, Smail A, Adam R, Cailliez V, Laurent A, Lemoine A, Bismuth H: Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg 231: 480–486, 2000

    Google Scholar 

  19. Urata K, Kawasaki S, Matsunami H, Hashikura Y, Ikegami T, Ishizone S, Momose Y, Komiyama A, Makuuchi M: Calculation of child and adult standard liver volume for liver transplantation. Hepatology 21: 1317–1321, 1995

    Google Scholar 

  20. Ogasawara K, Une Y, Nakajima Y, Uchino J: The significance of measuring liver volume using computed tomographic images before and after hepatectomy. Surg Today 25: 43–48, 1995

    Google Scholar 

  21. Soyer P, Roche A, Elias D, Levesque M: Hepatic metastases from colorectal cancer: Influence of hepatic volumetric analysis on surgical decision making. Radiology 184: 695–697, 1992

    Google Scholar 

  22. Nagino M, Nimura Y, Kamiya J, Kondo S, Uesaka K, Kin Y, Kutsuna Y, Hayakawa N, Yamamoto H: Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma. Surgery 117: 677–681, 1995

    Google Scholar 

  23. Nagino M, Kamiya J, Kanai M, Uesaka K, Sano T, Yamamoto H, Hayakawa N, Nimura Y: Right trisegment portal vein embolization for biliary tract carcinoma: Technique and clinical utility. Surgery 127: 155–160, 2000

    Google Scholar 

  24. Elias D, De Baere T, Roche A, Mducreux, Leclere J, Lasser P: During liver regeneration following right portal embolization the growth rate of liver metastases is more rapid than that of the liver parenchyma. Br J Surg 86: 784–788, 1999

    Google Scholar 

  25. de Baere T, Roche A, Elias D, Lasser P, Lagrange C, Bousson V: Preoperative portal vein embolization for extension of hepatectomy indications. Hepatology 24: 1386–1391, 1996

    Google Scholar 

  26. Imamura H, Shimada R, Kubota M, Matsuyama Y, Nakayama A, Miyagawa S, Makuuchi M, Kawasaki S: Preoperative portal vein embolization: An audit of 84 patients. Hepatology 29: 1099–1105, 1999

    Google Scholar 

  27. Shimamura T, Nakajima Y, Une Y, Namieno T, Ogasawara K, Yamashita K, Haneda T, Nakanishi K, Kimura J, Matsushita M, Sato N, Uchino J: Efficacy and safety of preoperative percutaneous transhepatic portal embolization with absolute ethanol: A clinical study. Surgery 121: 135–141, 1997

    Google Scholar 

  28. Makuuchi M, Kosuge T, Lygidakis NJ: New possibilities for major liver surgery in patients with Klatskin tumors or primary hepatocellular carcinoma-an old problem revisited. Hepatogastroenterology 38: 329–336, 1991

    Google Scholar 

  29. de Baere T, Roche A, Vavasseur D, Therasse E, Indushekar S, Elias D, Bognel C: Portal vein embolization: Utility for inducing left hepatic lobe hypertrophy before surgery. Radiology 188: 73–77, 1993

    Google Scholar 

  30. Nagino M, Nimura Y, Hayakawa N: Percutaneous transhepatic portal embolization using newly devised catheters: Preliminary report. World J Surg 17: 520–524, 1993

    Google Scholar 

  31. Kawasaki S, Makuuchi M, Miyagawa S, Kakazu T: Radical operation after portal embolization for tumor of hilar bile duct. J Am Coll Surg 178: 480–486, 1994

    Google Scholar 

  32. Nagino M, Nimura Y, Kamiya J, Kondo S, Uesaka K, Kin Y, Hayakawa N, Yamamoto H: Changes in hepatic lobe volume in biliary tract cancer patients after right portal vein embolization. Hepatology 21: 434–439, 1995

    Google Scholar 

  33. Wakabayashi H, Okada S, Maeba T, Maeta H: Effect of preoperative portal vein embolization on major hepatectomy for advanced-stage hepatocellular carcinomas in injured livers: A preliminary report. Surg Today 27: 403–410, 1997

    Google Scholar 

  34. Elias D, Cavalcanti A, De Baere T, Roche A, Lasser PH: Resultats carcinologiques a long terme des hepatectomies realisee apres embolisation portal selective. Ann Chi 53: 559–564, 1999

    Google Scholar 

  35. Abdalla EK, Hicks ME, Vauthey JN: Portal vein embolization: Rationale, technique and future prospects. Br J Surg 88: 165–175, 2001

    Google Scholar 

  36. LeVeen RF: Laser hyperthermia and radiofrequency ablation of hepatic lesions. Sem Interven Radiol 14: 313–324, 1997

    Google Scholar 

  37. Dickson JA, Calderwood SK: Temperature range and selective sensitivity of tumors to hyperthermia: A critical review. Ann N Y Acad Sci 335: 180–205, 1980

    Google Scholar 

  38. Hill RP, Hunt JW: Hyperthermia. In The Basic Science of Oncology. Tannock IF, Hill RP, eds. New York, Pergamon Press, 337–357, 1987

    Google Scholar 

  39. Haines DE, Watson DD, Halperin C: Characteristics of heat transfer and determination of temperature gradient and viability threshold during radiofrequency fulguration of isolated perfused canine right ventricle. Circulation 76: 278–282, 1987

    Google Scholar 

  40. Grundfest WS, Litvack FI, Doyle DL: Laser-tissue interactions: Considerations for cardiovascular applications. In Lasers in Cardiovascular Disease. White RA, Grundfest WS, eds. Chicago, Yearbook Medical Publishers, 32–43, 1987

    Google Scholar 

  41. Bischof J, Christov K, Rubinsky B: A morphological study of cooling rate response in normal and neoplastic human liver tissue: Cryosurgical implications. Cryobiology 30: 482–492, 1993

    Google Scholar 

  42. Steeves RA: Hyperthermia in cancer therapy: Where are we today and where are we going? Bull N Y Acad Med 68: 341–350, 1992

    Google Scholar 

  43. Siperstein AE, Rogers SJ, Hansen PD, Gitomirsky A: Laparoscopic thermal ablation of hepatic neuroendocrine tumor metastases. Surgery 122: 1147–1154; discussion 1154-1155, 1997

    Google Scholar 

  44. Goldburg SN, Gazelle GS, Solbiati L: Ablation of liver tumors using percutaneous RF therapy. Am J Res 170: 1023–1028, 1998

    Google Scholar 

  45. Lencioni R, Goletti O, Armillotta N, Paolicchi A, Moretti M, Cioni D, Donati F, Cicorelli A, Ricci S, Carrai M, Conte PF, Cavina E, Bartolozzi C: Radio-frequency thermal ablation of liver metastases with a cooled-tip electrode needle: Results of a pilot clinical trial. Eur Radiol 8: 1205–1211, 1998

    Google Scholar 

  46. Nagata Y, Hiraoka M, Nishimura Y, Masunaga S, Mitumori M, Okuno Y, Fujishiro M, Kanamori S, Horii N, Akuta K, Sasai K, Abe M, Fukuda Y: Clinical results of radiofrequency hyperthermia for malignant liver tumors. Int J Radiat Oncol Biol Phys 38: 359–365, 1997

    Google Scholar 

  47. McGahan JP, Brock JM, Tesluk H, Gu WZ, Schneider P, Browning PD: Hepatic ablation with use of radiofrequency electrocautery in the animal model. J Vasc Interv Radiol 3: 291–297, 1992

    Google Scholar 

  48. Curley SA, Izzo F, Delrio P, Ellis LM, Granchi J, Vallone P, Fiore F, Pignata S, Daniele B, Cremona F: Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: Results in 123 patients. Ann Surg 230: 1–8, 1999

    Google Scholar 

  49. Curley S, Izzo F, Ellis LM, Woodall M, Wolff R, Vauthey JN: Radiofrequency ablation of malignant liver tumors in 304 patients, Proceedings ASCO, p. 248A, 2000

  50. Curley SA, Davidson BS, Fleming RY, Izzo F, Stephens LC, Tinkey P, Cromeens D: Laparoscopically guided bipolar radiofrequency ablation of areas of porcine liver. Surg Endosc 11: 729–733, 1997

    Google Scholar 

  51. Patterson J, Strang R: The role of blood flow in hyperthermia. Int J Radiat Oncol Biol Phys 5: 235–241, 1979

    Google Scholar 

  52. Kolios MC, Sherar MD, Hunt JW: Large blood vessel cooling in heated tissues: A numerical study. Physics in Medicine and Biology 40: 477–494, 1995

    Google Scholar 

  53. Sturesson C, Liu DL, Stenram U, Andersson-Engels S: Hepatic inflow occlusion increases the efficacy of interstitial laser-induced thermotherapy in rat. J Surg Res 71: 67–72, 1997

    Google Scholar 

  54. Curley SA: Radiofrequency ablation of malignant liver tumors. Oncologist 6: 14–23, 2001

    Google Scholar 

  55. Solbiati L, Ierace T, Tonolini M, Osti V, Cova L: Radiofrequency thermal ablation of hepatic metastases. Eur J Ultrasound 13: 149–158, 2001

    Google Scholar 

  56. Siperstein A, Garland A, Engle K, Rogers S, Berber E, Foroutani A, String A, Ryan T, Ituarte P: Local recurrence after laparoscopic radiofrequency thermal ablation of hepatic tumors. Ann Surg Oncol 7: 106–113, 2000

    Google Scholar 

  57. Wood TF, Rose DM, Chung M, Allegra DP, Foshag LJ, Bilchik AJ: Radiofrequency ablation of 231 unresectable hepatic tumors: Indications, limitations, and complications. Ann Surg Oncol 7: 593–600, 2000

    Google Scholar 

  58. de Baere T, Elias D, Dromain C, Din MG, Kuoch V, Ducreux M, Boige V, Lassau N, Marteau V, Lasser P, Roche A: Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than 1 year. AJR Am J Roentgenol 175: 1619–1625, 2000

    Google Scholar 

  59. Bowles BJ, Machi J, Limm WM, Severino R, Oishi AJ, Furumoto NL, Wong LL, Oishi RH: Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors. Arch Surg 136: 864–869, 2001

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. Nicholas Vauthey.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Curley, S.A., Izzo, F., Abdalla, E. et al. Surgical treatment of colorectal cancer metastasis. Cancer Metastasis Rev 23, 165–182 (2004). https://doi.org/10.1023/A:1025875332255

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1025875332255

  • colorectal cancer
  • liver metastasis
  • surgery