Surgical Treatment of Colorectal Metastases to the Liver

  • Genoveffa Balducci
  • Paolo Mercantini
  • Niccolò Petrucciani
  • Vincenzo Ziparo
Part of the Updates in Surgery book series (UPDATESSURG)


The liver is the most common site of metastasis from colorectal cancer: about 50% of patients affected by colorectal cancer develop liver metastases during the course of their disease [1]; of these, 25% present with synchronous liver metastases, whereas an additional 25% develop metachronous hepatic metastases. Approximately 148,800 cases of colorectal cancer are estimated for 2008 in the United States, with more than 60,000 cases of liver metastases [2]. Patients with untreated metastatic colorectal cancer have a poor prognosis with a median survival of 6 to 12 months [3]. Surgical therapy for colorectal liver metastases remains the only potentially curative treatment. Despite recent advances in systemic chemotherapy, the median survival for unresected patients ranges from 12 to 24 months with uncommon long-term survival, while the 5-year survival rate after surgery ranges from 25 to 58%. These results are expected to improve with better patient selection and multimodal approaches. Therefore, when indicated, resection of colorectal metastases to the liver should always be considered.


Colorectal Cancer Liver Metastasis Liver Resection Hepatic Resection Colorectal Liver Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Simmonds PC, Primrose JN, Colquitt JL et al (2006) Surgical resection of hepatic metastases from colorectal cancer: a systematic review of the published studies. Br J Cancer 94:982–999PubMedCrossRefGoogle Scholar
  2. 2.
    Jemal A, Siegel R, Ward E et al (2008) Cancer Statistics, 2008. CA Cancer J Clin 58:71-96 3 Pawlik TM, Schulick RD, Choti MA (2008) Expanding criteria for resectability of colorectal liver metastases. Oncologist 13:51–64CrossRefGoogle Scholar
  3. 4.
    Schindl M, Wigmore SJ, Currie EJ et al (2005) Prognostic scoring in colorectal cancer liver metastases: development and validation. Arch Surg 140:183–189PubMedCrossRefGoogle Scholar
  4. 5.
    Wei AC, Greig PD, Grant D et al (2006) Survival after hepatic resection for colorectal metastases: a 10-year experience. Ann Surg Oncol 13:668–676PubMedCrossRefGoogle Scholar
  5. 6.
    Malik HZ, Prasad KR, Halazun KJ et al (2007) Preoperative prognostic score for predicting survival after hepatic resection for colorectal liver metastases. Ann Surg 246:806–814PubMedCrossRefGoogle Scholar
  6. 7.
    Arru M, Aldrighetti L, Castoldi R et al (2008) Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer. World J Surg 32:93–103PubMedCrossRefGoogle Scholar
  7. 8.
    Ambiru S, Miyazaki M, Isono T et al (1999) Hepatic resection for colorectal metastases: analysis of prognostic factors. Dis Colon Rectum 42:632–639PubMedCrossRefGoogle Scholar
  8. 9.
    Nuzzo G, Giulante F, Ardito F et al (2008) Influence of surgical margin on type of recurrence after liver resection for colorectal metastases: a single-center experience. Surgery 143:384–393PubMedCrossRefGoogle Scholar
  9. 10.
    Laurent C, Sa Cunha A, Couderc P et al (2003) Influence of postoperative morbidity on long-term survival following liver resection for colorectal metastases. Br J Surg 90:1131–1136PubMedCrossRefGoogle Scholar
  10. 11.
    Viganò L, Ferrero A, Lo Tesoriere R, Capussotti L (2008) Liver surgery for colorectal metas-tases: results after 10 years of follow-up. long-term survivors, late recurrences, and prognostic role of morbidity. Ann Surg Oncol May 8 [Epub ahead of print].Google Scholar
  11. 12.
    Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318PubMedCrossRefGoogle Scholar
  12. 13.
    Choti MA, Sitzmann JV, Tiburi MF et al (2002) Trends in long-term survival following liver resection for hepatic clorectal metastases. Ann Surg 235:759–766PubMedCrossRefGoogle Scholar
  13. 14.
    Fernandez FG, Drebin JA, Linehan DC et al (2004) Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg 240:438–447PubMedCrossRefGoogle Scholar
  14. 15.
    Pawlik TM, Scoggins CR, Zorzi D et al (2005) Effect of surgical margin status on survival ad site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241:715–722PubMedCrossRefGoogle Scholar
  15. 16.
    Guzzetti E, Pulitanò C, Catena M et al (2008) Impact of type of liver resection on the outcome of colorectal liver metastases: a case-matched analysis. J Surg Oncol 97:503–507PubMedCrossRefGoogle Scholar
  16. 17.
    Helling TS, Blondeau B (2005) Anatomic segmental resection compared to major hepatectomy in the treatment of liver neoplasms. HPB (Oxford) 7:222–225Google Scholar
  17. 18.
    Pawlik TM, Choti MA (2007) Surgical therapy for colorectal metastases to the liver. J Gastrointest Surg 11:1057–1077PubMedCrossRefGoogle Scholar
  18. 19.
    Covey AM, Brown KT, Jarnagin WR et al (2008) Combined portal vein embolization and neoadjuvant chemotherapy as a treatment strategy for resectable hepatic colorectal metastases. Ann Surg 247:451–455PubMedCrossRefGoogle Scholar
  19. 20.
    Adam R, Delvart V, Pascal G et al (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240:664–657CrossRefGoogle Scholar
  20. 21.
    Pawlik TM, Izzo F, Cohen DS et al (2003) Combined resection and radiofrequency ablation for advanced hepatic malignancies: results in 172 patients. Ann Surg Oncol 10:1059–1069PubMedCrossRefGoogle Scholar
  21. 22.
    Miller G, Biernacki P, Kemeny NE et al (2007) Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases. J Am Coll Surg 205:231–238PubMedCrossRefGoogle Scholar
  22. 23.
    Elias D, Ouellet JF, Bellon N et al (2003) Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg 90:567–574PubMedCrossRefGoogle Scholar
  23. 24.
    Ahmad A, Chen SL, Bilchik AJ (2007) Role of repeated hepatectomy in the multimodal treatment of hepatic colorectal metastases. Arch Surg 142:526–531PubMedCrossRefGoogle Scholar
  24. 25.
    Morise Z, Sugioka A, Fujita J et al (2006) Does repeated surgery improve the prognosis of colorectal liver metastases? J Gastrointest Surg 10:6–11PubMedCrossRefGoogle Scholar
  25. 26.
    Fukunaga K, Takada Y, Otsuka M et al (2003) Resection of localized recurrences after hepatectomy of colorectal cancer metastases. Hepatogastroenterology 50:1894–1897PubMedGoogle Scholar
  26. 27.
    Chiappa A, Zbar AP, Biella F, Staudacher C (1999) Survival after repeat hepatic resection for recurrent colorectal metastase. Hepatogastroenterology 46:1065–1070PubMedGoogle Scholar
  27. 28.
    Yamada H, Katoh H, Kondo S et al (2001) Repeat hepatectomy for recurrent hepatic metastases from colorectal cancer. Hepatogastroenterology 48:828–830PubMedGoogle Scholar
  28. 29.
    Petrowsky H, Gonen M, Jarnagin W et al (2002) Second liver resections are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: a bi-institutional analysis. Ann Surg 235:863–871PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  • Genoveffa Balducci
    • 1
  • Paolo Mercantini
    • 1
  • Niccolò Petrucciani
    • 1
  • Vincenzo Ziparo
    • 1
  1. 1.UOC Chirurgia A, Sant’Andrea HospitalUniversity of Rome “La Sapienza”RomeItaly

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