Skip to main content

Patient Selection and Surgical Approach to Colorectal Cancer Liver Metastases

  • Chapter
  • First Online:
  • 606 Accesses

Abstract

The management of complex colorectal cancer liver metastases continues to evolve as improvements in systemic chemotherapy, liver augmentation strategies, non-resectional therapies, surgical technologies, and perioperative care occur. Critical to optimizing patient outcomes is an orderly and consistent approach to patient selection as well as reliance on a multidisciplinary approach and utilization of all surgical tools available. Such an approach will permit the extension of curative-intent treatments to the largest number of patients.

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

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. American Cancer Society. Cancer facts & figures [internet]. Atlanta: American Cancer Society; 2016. http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf

    Google Scholar 

  2. Brouquet A, Abdalla EK, Kopetz S, Garrett CR, Overman MJ, Eng C, et al. High survival rate after two-stage resection of advanced colorectal liver metastases: response-based selection and complete resection define outcome. J Clin Oncol. 2011;29(8):1083–90.

    Article  Google Scholar 

  3. Mise Y, Aloia TA, Brudvik KW, Schwarz L, Vauthey J-N, Conrad C. Parenchymal-sparing hepatectomy in colorectal liver metastasis improves salvageability and survival. Ann Surg. 2016;263(1):146–52.

    Article  Google Scholar 

  4. Passot G, Chun YS, Kopetz SE, Zorzi D, Brudvik KW, Kim BJ, et al. Predictors of safety and efficacy of 2-stage hepatectomy for bilateral colorectal liver metastases. J Am Coll Surg. 2016;223(1):99–108.

    Article  Google Scholar 

  5. Chun YS, Vauthey J-N, Ribero D, Donadon M, Mullen JT, Eng C, et al. Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival. J Gastrointest Surg. 2007;11(11):1498–504; discussion 1504–1505.

    Article  Google Scholar 

  6. Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217(5):833–842.e1-3.

    Article  Google Scholar 

  7. Wagner D, Büttner S, Kim Y, Gani F, Xu L, Margonis GA, et al. Clinical and morphometric parameters of frailty for prediction of mortality following hepatopancreaticobiliary surgery in the elderly. Br J Surg. 2016;103(2):e83–92.

    Article  CAS  Google Scholar 

  8. Reddy S, Contreras CM, Singletary B, Bradford TM, Waldrop MG, Mims AH, et al. Timed stair climbing is the single strongest predictor of perioperative complications in patients undergoing abdominal surgery. J Am Coll Surg. 2016;222(4):559–66.

    Article  Google Scholar 

  9. Hadden WJ, de Reuver PR, Brown K, Mittal A, Samra JS, Hugh TJ. Resection of colorectal liver metastases and extra-hepatic disease: a systematic review and proportional meta-analysis of survival outcomes. HPB. 2016;18(3):209–20.

    Article  Google Scholar 

  10. Karagkounis G, Torbenson MS, Daniel HD, Azad NS, Diaz LA, Donehower RC, et al. Incidence and prognostic impact of KRAS and BRAF mutation in patients undergoing liver surgery for colorectal metastases. Cancer. 2013;119(23):4137–44.

    Article  CAS  Google Scholar 

  11. Vauthey JN, Chaoui A, Do KA, Bilimoria MM, Fenstermacher MJ, Charnsangavej C, et al. Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery. 2000;127(5):512–9.

    Article  CAS  Google Scholar 

  12. Kishi Y, Abdalla EK, Chun YS, Zorzi D, Madoff DC, Wallace MJ, et al. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg. 2009;250(4):540–8.

    PubMed  Google Scholar 

  13. Azoulay D, Castaing D, Smail A, Adam R, Cailliez V, Laurent A, et al. Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg. 2000;231(4):480–6.

    Article  CAS  Google Scholar 

  14. Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber J-C, Bachellier P. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg. 2004;240(6):1037–49; discussion 1049–1051.

    Article  Google Scholar 

  15. Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371(9617):1007–16.

    Article  CAS  Google Scholar 

  16. Kishi Y, Zorzi D, Contreras CM, Maru DM, Kopetz S, Ribero D, et al. Extended preoperative chemotherapy does not improve pathologic response and increases postoperative liver insufficiency after hepatic resection for colorectal liver metastases. Ann Surg Oncol. 2010;17(11):2870–6.

    Article  Google Scholar 

  17. Ribero D, Wang H, Donadon M, Zorzi D, Thomas MB, Eng C, et al. Bevacizumab improves pathologic response and protects against hepatic injury in patients treated with oxaliplatin-based chemotherapy for colorectal liver metastases. Cancer. 2007;110(12):2761–7.

    Article  Google Scholar 

  18. Chun YS, Vauthey J-N, Boonsirikamchai P, Maru DM, Kopetz S, Palavecino M, et al. Association of computed tomography morphologic criteria with pathologic response and survival in patients treated with bevacizumab for colorectal liver metastases. JAMA. 2009;302(21):2338–44.

    Article  CAS  Google Scholar 

  19. Blazer DG, Kishi Y, Maru DM, Kopetz S, Chun YS, Overman MJ, et al. Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases. J Clin Oncol. 2008;26(33):5344–51.

    Article  Google Scholar 

  20. Passot G, Odisio BC, Zorzi D, Mahvash A, Gupta S, Wallace MJ, et al. Eradication of missing liver metastases after fiducial placement. J Gastrointest Surg. 2016;20(6):1173–8.

    Article  Google Scholar 

  21. Andreou A, Aloia TA, Brouquet A, Dickson PV, Zimmitti G, Maru DM, et al. Margin status remains an important determinant of survival after surgical resection of colorectal liver metastases in the era of modern chemotherapy. Ann Surg. 2013;257(6):1079–88.

    Article  Google Scholar 

  22. Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A, Eng C, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241(5):715–22; discussion 722–724.

    Article  Google Scholar 

  23. Sadot E, Groot Koerkamp B, Leal JN, Shia J, Gonen M, Allen PJ, et al. Resection margin and survival in 2368 patients undergoing hepatic resection for metastatic colorectal cancer: surgical technique or biologic surrogate? Ann Surg. 2015;262(3):476–85; discussion 483–485.

    Article  Google Scholar 

  24. Brudvik KW, Mise Y, Chung MH, Chun YS, Kopetz SE, Passot G, et al. RAS mutation predicts positive resection margins and narrower resection margins in patients undergoing resection of colorectal liver metastases. Ann Surg Oncol. 2016;23(8):2635–43.

    Article  Google Scholar 

  25. Mise Y, Zimmitti G, Shindoh J, Kopetz S, Loyer EM, Andreou A, et al. RAS mutations predict radiologic and pathologic response in patients treated with chemotherapy before resection of colorectal liver metastases. Ann Surg Oncol. 2015;22(3):834–42.

    Article  Google Scholar 

  26. Kinoshita H, Sakai K, Hirohashi K, Igawa S, Yamasaki O, Kubo S. Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg. 1986;10(5):803–8.

    Article  CAS  Google Scholar 

  27. Makuuchi M, Thai BL, Takayasu K, Takayama T, Kosuge T, Gunvén P, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990;107(5):521–7.

    CAS  PubMed  Google Scholar 

  28. Madoff DC, Abdalla EK, Gupta S, Wu T-T, Morris JS, Denys A, et al. Transhepatic ipsilateral right portal vein embolization extended to segment IV: improving hypertrophy and resection outcomes with spherical particles and coils. J Vasc Interv Radiol JVIR. 2005;16(2 Pt 1):215–25.

    Article  Google Scholar 

  29. Hwang S, Lee S-G, Ko G-Y, Kim B-S, Sung K-B, Kim M-H, et al. Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy. Ann Surg. 2009;249(4):608–16.

    Article  Google Scholar 

  30. Ribero D, Abdalla EK, Madoff DC, Donadon M, Loyer EM, Vauthey J-N. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg. 2007;94(11):1386–94.

    Article  CAS  Google Scholar 

  31. Shindoh J, Truty MJ, Aloia TA, Curley SA, Zimmitti G, Huang SY, et al. Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant. J Am Coll Surg. 2013;216(2):201–9.

    Article  Google Scholar 

  32. Bleicher RJ, Allegra DP, Nora DT, Wood TF, Foshag LJ, Bilchik AJ. Radiofrequency ablation in 447 complex unresectable liver tumors: lessons learned. Ann Surg Oncol. 2003;10(1):52–8.

    Article  Google Scholar 

  33. Kennedy TJ, Cassera MA, Khajanchee YS, Diwan TS, Hammill CW, Hansen PD. Laparoscopic radiofrequency ablation for the management of colorectal liver metastases: 10-year experience. J Surg Oncol. 2013;107(4):324–8.

    Article  Google Scholar 

  34. Berber E, Pelley R, Siperstein AE. Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: a prospective study. J Clin Oncol. 2005;23(7):1358–64.

    Article  Google Scholar 

  35. Stang A, Fischbach R, Teichmann W, Bokemeyer C, Braumann D. A systematic review on the clinical benefit and role of radiofrequency ablation as treatment of colorectal liver metastases. Eur J Cancer. 2009;45(10):1748–56.

    Article  Google Scholar 

  36. Xing M, Kooby DA, El-Rayes BF, Kokabi N, Camacho JC, Kim HS. Locoregional therapies for metastatic colorectal carcinoma to the liver—an evidence-based review. J Surg Oncol. 2014;110(2):182–96.

    Article  Google Scholar 

  37. Colbert LE, Cloyd JM, Koay EJ, Crane CH, Vauthey J-N. Proton beam radiation as salvage therapy for bilateral colorectal liver metastases not amenable to second-stage hepatectomy. Surgery. 2017;161(6):1543–8.

    Article  Google Scholar 

  38. van Hazel GA, Heinemann V, Sharma NK, Findlay MPN, Ricke J, Peeters M, et al. SIRFLOX: randomized phase III trial comparing first-line mFOLFOX6 (plus or minus bevacizumab) versus mFOLFOX6 (plus or minus bevacizumab) plus selective internal radiation therapy in patients with metastatic colorectal cancer. J Clin Oncol. 2016;34(15):1723–31.

    Article  Google Scholar 

  39. Wei M, He Y, Wang J, Chen N, Zhou Z, Wang Z. Laparoscopic versus open hepatectomy with or without synchronous colectomy for colorectal liver metastasis: a meta-analysis. PLoS One. 2014;9(1):e87461.

    Article  Google Scholar 

  40. Cardinal JS, Reddy SK, Tsung A, Marsh JW, Geller DA. Laparoscopic major hepatectomy: pure laparoscopic approach versus hand-assisted technique. J Hepatobiliary Pancreat Sci. 2013;20(2):114–9.

    Article  CAS  Google Scholar 

  41. Komatsu S, Scatton O, Goumard C, Sepulveda A, Brustia R, Perdigao F, et al. Development process and technical aspects of laparoscopic hepatectomy: learning curve based on 15 years of experience. J Am Coll Surg. 2017;224(5):841–50.

    Article  Google Scholar 

  42. Viganò L, Ferrero A, Amisano M, Russolillo N, Capussotti L. Comparison of laparoscopic and open intraoperative ultrasonography for staging liver tumours. Br J Surg. 2013;100(4):535–42.

    Article  Google Scholar 

  43. Torzilli G, Procopio F, Botea F, Marconi M, Del Fabbro D, Donadon M, et al. One-stage ultrasonographically guided hepatectomy for multiple bilobar colorectal metastases: a feasible and effective alternative to the 2-stage approach. Surgery. 2009;146(1):60–71.

    Article  Google Scholar 

  44. Gold JS, Are C, Kornprat P, Jarnagin WR, Gönen M, Fong Y, et al. Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg. 2008;247(1):109–17.

    Article  Google Scholar 

  45. Abdalla EK, Vauthey J-N, Ellis LM, Ellis V, Pollock R, Broglio KR, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239(6):818–25; discussion 825–827.

    Article  Google Scholar 

  46. 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(6):777–85.

    Article  CAS  Google Scholar 

  47. Schnitzbauer AA, Lang SA, Goessmann H, Nadalin S, Baumgart J, Farkas SA, et al. 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(3):405–14.

    Article  Google Scholar 

  48. Ratti F, Schadde E, Masetti M, Massani M, Zanello M, Serenari M, et al. Strategies to increase the resectability of patients with colorectal liver metastases: a multi-center case-match analysis of ALPPS and conventional two-stage hepatectomy. Ann Surg Oncol. 2015;22(6):1933–42.

    Article  Google Scholar 

  49. Schadde E, Ardiles V, Robles-Campos R, Malago M, Machado M, Hernandez-Alejandro R, et al. Early survival and safety of ALPPS: first report of the international ALPPS registry. Ann Surg. 2014;260(5):829–36; discussion 836–838.

    Article  Google Scholar 

  50. Alvarez FA, Ardiles V, de Santibañes M, Pekolj J, de Santibañes E. Associating liver partition and portal vein ligation for staged hepatectomy offers high oncological feasibility with adequate patient safety: a prospective study at a single center. Ann Surg. 2015;261(4):723–32.

    Article  Google Scholar 

  51. Oldhafer KJ, Donati M, Jenner RM, Stang A, Stavrou GA. ALPPS for patients with colorectal liver metastases: effective liver hypertrophy, but early tumor recurrence. World J Surg. 2014;38(6):1504–9.

    Article  Google Scholar 

  52. Wicherts DA, Miller R, de Haas RJ, Bitsakou G, Vibert E, Veilhan L-A, et al. Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Ann Surg. 2008;248(6):994–1005.

    Article  Google Scholar 

  53. Kemeny N, Daly J, Reichman B, Geller N, Botet J, Oderman P. Intrahepatic or systemic infusion of fluorodeoxyuridine in patients with liver metastases from colorectal carcinoma. A randomized trial. Ann Intern Med. 1987;107(4):459–65.

    Article  CAS  Google Scholar 

  54. Ducreux M, Ychou M, Laplanche A, Gamelin E, Lasser P, Husseini F, et al. Hepatic arterial oxaliplatin infusion plus intravenous chemotherapy in colorectal cancer with inoperable hepatic metastases: a trial of the gastrointestinal group of the Federation Nationale des Centres de Lutte Contre le Cancer. J Clin Oncol. 2005;23(22):4881–7.

    Article  CAS  Google Scholar 

  55. Boige V, Malka D, Elias D, Castaing M, De Baere T, Goere D, et al. Hepatic arterial infusion of oxaliplatin and intravenous LV5FU2 in unresectable liver metastases from colorectal cancer after systemic chemotherapy failure. Ann Surg Oncol. 2008;15(1):219–26.

    Article  Google Scholar 

  56. Kemeny N, Gonen M, Sullivan D, Schwartz L, Benedetti F, Saltz L, et al. Phase I study of hepatic arterial infusion of floxuridine and dexamethasone with systemic irinotecan for unresectable hepatic metastases from colorectal cancer. J Clin Oncol. 2001;19(10):2687–95.

    Article  CAS  Google Scholar 

  57. Kemeny NE, Melendez FDH, Capanu M, Paty PB, Fong Y, Schwartz LH, et al. Conversion to resectability using hepatic artery infusion plus systemic chemotherapy for the treatment of unresectable liver metastases from colorectal carcinoma. J Clin Oncol. 2009;27(21):3465–71.

    Article  Google Scholar 

  58. Karanicolas PJ, Metrakos P, Chan K, Asmis T, Chen E, Kingham TP, et al. Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement. Curr Oncol. 2014;21(1):e129–36.

    Article  CAS  Google Scholar 

  59. Zacharias AJ, Jayakrishnan TT, Rajeev R, Rilling WS, Thomas JP, George B, et al. Comparative effectiveness of hepatic artery based therapies for unresectable colorectal liver metastases: a meta-analysis. PLoS One. 2015;10(10):e0139940.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas A. Aloia .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Cloyd, J.M., Aloia, T.A. (2018). Patient Selection and Surgical Approach to Colorectal Cancer Liver Metastases. In: Cardona, K., Maithel, S. (eds) Primary and Metastatic Liver Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-91977-5_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-91977-5_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91976-8

  • Online ISBN: 978-3-319-91977-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics