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Colorectal Carcinoma Liver Metastasis: Surgical Clinical Perspective

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Liver Metastasis: Biology and Clinical Management

Part of the book series: Cancer Metastasis - Biology and Treatment ((CMBT,volume 16))

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Abstract

Few malignancies have their prognosis changed by resection of their metastatic deposits. Why this should be possible with colorectal cancer is being investigated by researchers worldwide. This observation, however, has seen surgical therapy of colorectal liver metastases witness revolutionary changes over the past years. Historically, liver resection was seen as a formidable operation fraught with complications. Perioperative safety has improved and specialist centers performing liver resection for colorectal liver metastases are reporting operative mortality rates of less than 1%. A challenge for the future is to make more patients eligible for curative intent surgery by downstaging the tumours with chemotherapy to make them resectable. Specialist centers are expanding the operations applied to this disease with vein resection, interposition vascular grafting, in-vivo liver isolation even ex vivo resections with re-implantation of the liver. Surgery is becoming safer for the patient and chemotherapy is slowing the progress of metastatic colorectal cancer to allow surgery to add more effectively to increase patient survival. Five year survival rates continue to improve. Chemotherapy does have effects on the liver which at times limit the possibilities for resection; however, newer therapies, combinations of therapies, timing and shorter courses of therapy see similar tumour responses without the deleterious effects. The amount of liver remaining after resection also limits which tumours are technically resectable. The volume of residual liver required has been further defined. Portal vein embolization can preoperatively selectively hypertrophy the future liver which the patient will be dependant upon. Better imaging and volumetric analysis has seen an extension of the criteria of what is thought resectable. Tumour margins of the resected specimen have been shown to be important only if less than 1 mm, therefore expanding the indications for resection. The evolving field of chemotherapeutics will continue to push the limits of tumour response. These improvements will see dynamic changes in the roles of the members of the multidisciplinary cancer care team.

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Notes

  1. 1.

    The tumor status following treatment is described by the residual tumor (R) classification: R0, no residual tumor; R1, microscopic residual tumor; R2, macroscopic residual tumor. Residual tumor may be found in the area of primary tumor and its regional lymph nodes and/or at distant sites. The R classification reflects the effects of treatment and influences further treatment planning. Furthermore, the R classification is a strong predictor of prognosis. An acceptable long-term prognosis can be expected only in R0 patients. Although there exist clear correlations between stage and R classification, the differences in prognosis of R0 versus R1, 2 cannot be explained by differences in stage alone. The prognostic significance of R classification is demonstrated by respective data for non-small cell lung carcinoma, squamous cell carcinoma of oesophagus, gastric carcinoma, ductal adenocarcinoma of the pancreas, colorectal carcinoma, lung and liver metastases [80].

Abbreviations

CLMs:

colorectal liver metastases

CEA:

carcinoembryonic antigen

CT:

computerized tomography

MRI:

magnetic resonance imaging

FAP:

familial adenomatous polyposis

FLR:

future liver remnant

NAFLD:

non-alcoholic fatty liver disease

PET:

positron emission tomographic scan

MCC:

Multidisciplinary Cancer Conference

IVC:

inferior vena cava

PVE:

portal vein embolization

RFA:

radiofrequency ablation

References

  1. Goldberg RM, Rothenberg ML, Van Cutsem E, Benson AB 3rd, Blanke CD, Diasio RB et al (2007) The continuum of care: a paradigm for the management of metastatic colorectal cancer. Oncologist 12:38–50

    Article  PubMed  Google Scholar 

  2. Jaeck D, Pessaux P (2008) Bilobar colorectal liver metastases: treatment options. Surg Oncol Clin N Am 17:553–568, ix

    Article  PubMed  Google Scholar 

  3. Berri RN, Abdalla EK (2009) Curable metastatic colorectal cancer: recommended paradigms. Curr Oncol Rep 11:200–208

    Article  PubMed  Google Scholar 

  4. Benoist S, Nordlinger B (2009) The role of preoperative chemotherapy in patients with resectable colorectal liver metastases. Ann Surg Oncol 16:2385–2390

    Article  PubMed  Google Scholar 

  5. Carpizo DR, Are C, Jarnagin W, Dematteo R, Fong Y, Gonen M et al (2009) Liver resection for metastatic colorectal cancer in patients with concurrent extrahepatic disease: results in 127 patients treated at a single center. Ann Surg Oncol 16:2138–2146

    Article  PubMed  Google Scholar 

  6. Lochan R, White SA, Manas DM (2007) Liver resection for colorectal liver metastasis. Surg Oncol 16:33–45

    Article  PubMed  CAS  Google Scholar 

  7. Tournigand C, Andre T, Achille E, Lledo G, Flesh M, Mery-Mignard D et al (2004) FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 22:229–237

    Article  PubMed  CAS  Google Scholar 

  8. Shimada H, Tanaka K, Endou I, Ichikawa Y (2009) Treatment for colorectal liver metastases: a review. Langenbeck’s Arch Surg/Deutsche Gesellschaft fur Chirurgie. Langenbecks Arch Surg 394:973–983. http://www.ncbi.nlm.nih.gov/pubmed/19582473. Epub 7 Jul 2009

    Google Scholar 

  9. Kimura T, Akazai Y, Iwagaki H, Nonaka Y, Ariki N, Fuchimoto S et al (1995) Metachronous liver metastasis of colorectal cancer: timing of occurrence and efficacy of adjuvant portal chemotherapy. Anticancer Res 15:1585–1588

    Google Scholar 

  10. Jeffery M, Hickey BE, Hider PN (2007) Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev, CD002200

    Google Scholar 

  11. Renehan AG, Egger M, Saunders MP, O’Dwyer ST (2002) Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. BMJ 324:813

    Google Scholar 

  12. Figueredo A, Rumble RB, Maroun J, Earle CC, Cummings B, McLeod R et al (2003) Follow-up of patients with curatively resected colorectal cancer: a practice guideline. BMC Cancer 3:26

    Google Scholar 

  13. Mauri D, Pentheroudakis G, Milousis A, Xilomenos A, Panagoulopoulou E, Bristianou M et al (2006) Colorectal cancer screening awareness in European primary care. Cancer Detect Prev 30:75–82

    Article  PubMed  Google Scholar 

  14. Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T (2003) Emergency surgery for colon carcinoma. Dis Colon Rectum 46:24–30

    Article  PubMed  Google Scholar 

  15. Wright F (2006) Multidisciplinary Cancer Conference Standards: The Evidentiary Review [Developed by the Expert Panel on Multidisciplinary Cancer Conference Standards, Cancer Care Ontario, Report Date: June 1, 2006]; Available from: http://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=36872. Accessed Oct 2009

  16. http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_colon_and_rectum_cancer.asp. http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_colon_and_rectum_cancer.asp. Available from: http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_colon_and_rectum_cancer.asp. Accessed Oct 2009

  17. http://seer.cancer.gov/statfacts/html/colorect.html. http://seer.cancer.gov/statfacts/html/colorect.html. http://seer.cancer.gov/statfacts/html/colorect.html; Available from: http://seer.cancer.gov/statfacts/html/colorect.html. Accessed Oct 2009

  18. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318; discussion 18–21

    Article  PubMed  CAS  Google Scholar 

  19. Garden OJ, Rees M, Poston GJ, Mirza D, Saunders M, Ledermann J et al (2006) Guidelines for resection of colorectal cancer liver metastases. Gut 55:iii1–8

    Google Scholar 

  20. Blyth S, Blakeborough A, Peterson M, Cameron IC, Majeed AW (2008) Sensitivity of magnetic resonance imaging in the detection of colorectal liver metastases. Ann R Coll Surg Engl 90:25–28

    Article  PubMed  CAS  Google Scholar 

  21. Nikoloudis N, Saliangas K, Economou A, Andreadis E, Siminou S, Manna I et al (2004) Synchronous colorectal cancer. Tech Coloproctol 8:S177–S179

    Google Scholar 

  22. Gatalica Z, Torlakovic E (2008) Pathology of the hereditary colorectal carcinoma. Fam Cancer 7:15–26

    Article  PubMed  Google Scholar 

  23. Abdalla EK, Barnett CC, Doherty D, Curley SA, Vauthey JN (2002) Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 137:675–680; discussion 80–81

    Article  PubMed  Google Scholar 

  24. Hemming AW, Scudamore CH, Shackleton CR, Pudek M, Erb SR (1992) Indocyanine green clearance as a predictor of successful hepatic resection in cirrhotic patients. Am J Surg 163:515–518

    Article  PubMed  CAS  Google Scholar 

  25. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC et al (2004) Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 40:1387–1395

    Google Scholar 

  26. Nomura H, Kashiwagi S, Hayashi J, Kajiyama W, Tani S, Goto M (1988) Prevalence of fatty liver in a general population of Okinawa, Japan. Jpn J Med 27:142–149

    CAS  Google Scholar 

  27. Gomez D, Malik HZ, Bonney GK, Wong V, Toogood GJ, Lodge JP et al (2000) Steatosis predicts postoperative morbidity following hepatic resection for colorectal metastasis. Br J Surg 94:1395–1402

    Google Scholar 

  28. Cho CS, Curran S, Schwartz LH, Kooby DA, Klimstra DS, Shia J et al (2008) Preoperative radiographic assessment of hepatic steatosis with histologic correlation. J Am Coll Surg 206:480–488

    Article  PubMed  Google Scholar 

  29. Pawlik TM, Schulick RD, Choti MA (2008) Expanding criteria for resectability of colorectal liver metastases. Oncologist 13:51–64

    Article  PubMed  Google Scholar 

  30. Pilkington SA, Rees M, Peppercorn D, John TG (2007) Laparoscopic staging in selected patients with colorectal liver metastases as a prelude to liver resection. HPB (Oxford) 9:58–63

    Google Scholar 

  31. Mann CD, Neal CP, Metcalfe MS, Pattenden CJ, Dennison AR, Berry DP (2007) Clinical risk score predicts yield of staging laparoscopy in patients with colorectal liver metastases. Br J Surg 94:855–859

    Article  PubMed  CAS  Google Scholar 

  32. Grundmann RT, Hermanek P, Merkel S, Germer CT, Grundmann RT, Hauss J et al (2008) Diagnosis and treatment of colorectal liver metastases – workflow. Zentralbl Chir 133:267–284

    Article  PubMed  CAS  Google Scholar 

  33. Gallinger S (2010) The impact of positron emission tomography (PET) imaging prior to liver resection for colorectal adenocarcinoma metastases: a prospective, multicentre randomized clinical trial. Available from: http://clinicaltrials.gov/ct2/show/study/NCT00265356 (ahead of print)

  34. Ribero D, Abdalla EK, Madoff DC, Donadon M, Loyer EM, Vauthey JN (2007) Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg 94:1386–1394

    Article  PubMed  CAS  Google Scholar 

  35. Aussilhou B, Dokmak S, Faivre S, Paradis V, Vilgrain V, Belghiti J (2009) Preoperative liver hypertrophy induced by portal flow occlusion before major hepatic resection for colorectal metastases can be impaired by bevacizumab. Ann Surg Oncol 16:1553–1559

    Article  PubMed  Google Scholar 

  36. Charnsangavej C, Clary B, Fong Y, Grothey A, Pawlik TM, Choti MA (2006) Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 13:1261–1268

    Article  PubMed  Google Scholar 

  37. Chun YS, Vauthey JN, Ribero D, Donadon M, Mullen JT, Eng C et al (2007) Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival. J Gastrointest Surg 11:1498–1504; discussion 504–505

    Article  PubMed  Google Scholar 

  38. Lupinacci R, Penna C, Nordlinger B (2007) Hepatectomy for resectable colorectal cancer metastases – indicators of prognosis, definition of resectability, techniques and outcomes. Surg Oncol Clin N Am 16:493–506, vii–viii

    Article  PubMed  Google Scholar 

  39. Adams RB, Haller DG, Roh MS (2006) Improving resectability of hepatic colorectal metastases: expert consensus statement by Abdalla et al. Ann Surg Oncol 13:1281–1283

    Google Scholar 

  40. de Haas RJ, Wicherts DA, Adam R (2008) Resection of colorectal liver metastases with extrahepatic disease. Dig Surg 25:461–466

    Article  PubMed  Google Scholar 

  41. Elias D, Liberale G, Vernerey D, Pocard M, Ducreux M, Boige V et al (2005) Hepatic and extrahepatic colorectal metastases: when resectable, their localization does not matter, but their total number has a prognostic effect. Ann Surg Oncol 12:900–909

    Article  PubMed  Google Scholar 

  42. Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P et al (2008) 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 371:1007–1016

    Article  PubMed  CAS  Google Scholar 

  43. Tamandl D, Gruenberger B, Herberger B, Kaczirek K, Gruenberger T (2009) Surgery after neoadjuvant chemotherapy for colorectal liver metastases is safe and feasible in elderly patients. J Surg Oncol 100:364–371

    Article  PubMed  Google Scholar 

  44. Nordlinger B, Van Cutsem E, Gruenberger T, Glimelius B, Poston G, Rougier P et al (2009) Combination of surgery and chemotherapy and the role of targeted agents in the treatment of patients with colorectal liver metastases: recommendations from an expert panel. Ann Oncol 20:985–992

    Article  PubMed  CAS  Google Scholar 

  45. Pozzo C, Barone C, Kemeny NE (2008) Advances in neoadjuvant therapy for colorectal cancer with liver metastases. Cancer Treat Rev 34:293–301

    Article  PubMed  CAS  Google Scholar 

  46. Pozzo C, Basso M, Cassano A, Quirino M, Schinzari G, Trigila N et al (2004) Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients. Ann Oncol 15:933–939

    Article  PubMed  CAS  Google Scholar 

  47. Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D et al (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240:644–657; discussion 57–58

    PubMed  Google Scholar 

  48. Giacchetti S, Itzhaki M, Gruia G, Adam R, Zidani R, Kunstlinger F et al (1999) Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery. Ann Oncol 10:663–669

    Article  PubMed  CAS  Google Scholar 

  49. Van den Eynde M, Hendlisz A (2009) Treatment of colorectal liver metastases: a review. Rev Recent Clin Trials 4:56–62

    Article  PubMed  Google Scholar 

  50. Benoist S, Brouquet A, Penna C, Julie C, El Hajjam M, Chagnon S et al (2006) Complete response of colorectal liver metastases after chemotherapy: does it mean cure? J Clin Oncol 24:3939–3945

    Article  PubMed  Google Scholar 

  51. Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K et al (2003) One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 138:1198–1206; discussion 206

    Article  PubMed  Google Scholar 

  52. Heriot AG, Karanjia ND (2002) A review of techniques for liver resection. Ann R Coll Surg Engl 84:371–380

    Article  PubMed  CAS  Google Scholar 

  53. Yamamoto J, Sugihara K, Kosuge T, Takayama T, Shimada K, Yamasaki S et al (1995) Pathologic support for limited hepatectomy in the treatment of liver metastases from colorectal cancer. Ann Surg 221:74–78

    Article  PubMed  CAS  Google Scholar 

  54. Scheele J, Stang R, Altendorf-Hofmann A, Paul M (1995) Resection of colorectal liver metastases. World J Surg 19:59–71

    Article  PubMed  CAS  Google Scholar 

  55. Kokudo N, Miki Y, Sugai S, Yanagisawa A, Kato Y, Sakamoto Y et al (2002) Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection. Arch Surg 137:833–840

    Article  PubMed  Google Scholar 

  56. Zorzi D, Mullen JT, Abdalla EK, Pawlik TM, Andres A, Muratore A et al (2006) Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. J Gastrointest Surg 10:86–94

    Article  PubMed  Google Scholar 

  57. Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R (2001) Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg 193:109–111

    Article  PubMed  CAS  Google Scholar 

  58. Lai EC, Fan ST, Lo CM, Chu KM, Liu CL (1996) Anterior approach for difficult major right hepatectomy. World J Surg 20:314–317; discussion 8

    Article  PubMed  CAS  Google Scholar 

  59. Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H (2000) Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 232:777–785

    Article  PubMed  CAS  Google Scholar 

  60. Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber JC, Bachellier P (2004) 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 240:1037–1049; discussion 49–51

    Article  PubMed  Google Scholar 

  61. Elias D, De Baere T, Roche A, Mducreux, Leclere J, Lasser P (1999) 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

    Article  PubMed  CAS  Google Scholar 

  62. Jaeck D, Abdalla EK (2009) Curable metastatic colorectal liver metastases. Ann Surg 11:200–208

    Google Scholar 

  63. Langenhoff BS, Krabbe PF, Ruers TJ (2009) Efficacy of follow-up after surgical treatment of colorectal liver metastases. Eur J Surg Oncol 35:180–186

    PubMed  CAS  Google Scholar 

  64. Yan TD, Sim J, Black D, Niu R, Morris DL (2007) Systematic review on safety and efficacy of repeat hepatectomy for recurrent liver metastases from colorectal carcinoma. Ann Surg Oncol 14:2069–2077

    Article  PubMed  Google Scholar 

  65. Karanjia ND, Lordan JT, Fawcett WJ, Quiney N, Worthington TR (2009) Survival and recurrence after neo-adjuvant chemotherapy and liver resection for colorectal metastases: a ten year study. Eur J Surg Oncol 35:838–843

    PubMed  CAS  Google Scholar 

  66. Meyerhardt JA, Mayer RJ (2005) Systemic therapy for colorectal cancer. N Engl J Med 352:476–487

    Article  PubMed  CAS  Google Scholar 

  67. Vauthey JN, Pawlik TM, Ribero D, Wu TT, Zorzi D, Hoff PM et al (2006) Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 24:2065–2072

    Article  PubMed  CAS  Google Scholar 

  68. Chun YS, Laurent A, Maru D, Vauthey JN (2009) Management of chemotherapy-associated hepatotoxicity in colorectal liver metastases. Lancet Oncol 10:278–286

    Article  PubMed  CAS  Google Scholar 

  69. Abdalla EK, Vauthey JN (2008) Chemotherapy prior to hepatic resection for colorectal liver metastases: helpful until harmful? Dig Surg 25:421–429

    Article  PubMed  CAS  Google Scholar 

  70. Parikh AA, Gentner B, Wu TT, Curley SA, Ellis LM, Vauthey JN (2003) Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy. J Gastrointest Surg 7:1082–1088

    Article  PubMed  Google Scholar 

  71. Shirasaka T, Taguchi T (2006) Timeline from discovery of 5-FU to development of an oral anticancer agent S-1 and its drug concept. Gan To Kagaku Ryoho 33:4–18

    PubMed  CAS  Google Scholar 

  72. Piedbois P, Buyse M, Rustum Y, Machover D, Erlichman C, Carlson RW, Valone F, Labianca R, Doroshow JH, Petrelli N (1992, June) Modulation of fluorouracil by leucovorin in patients with advanced colorectal cancer: evidence in terms of response rate. Advanced Colorectal Cancer Meta-Analysis Project. J Clin Oncol 10:896–903

    Google Scholar 

  73. Kohne CH, Lenz HJ (2009) Chemotherapy with targeted agents for the treatment of metastatic colorectal cancer. Oncologist 14:478–488

    Article  PubMed  Google Scholar 

  74. Peppercorn PD, Reznek RH, Wilson P, Slevin ML, Gupta RK (1998) Demonstration of hepatic steatosis by computerized tomography in patients receiving 5-fluorouracil-based therapy for advanced colorectal cancer. Br J Cancer 77:2008–2011

    Article  PubMed  CAS  Google Scholar 

  75. Ribero D, Wang H, Donadon M, Zorzi D, Thomas MB, Eng C et al (2007) Bevacizumab improves pathologic response and protects against hepatic injury in patients treated with oxaliplatin-based chemotherapy for colorectal liver metastases. Cancer 110:2761–2767

    Article  PubMed  Google Scholar 

  76. Van Cutsem E, Kohne CH, Hitre E, Zaluski J, Chang Chien CR, Makhson A et al (2009) Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med 360:1408–1417

    Article  PubMed  Google Scholar 

  77. Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A, Eng C et al (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241:715–722; discussion 22–24

    Article  PubMed  Google Scholar 

  78. Cohen SJ, Punt CJ, Iannotti N, Saidman BH, Sabbath KD, Gabrail NY et al (2009) Prognostic significance of circulating tumor cells in patients with metastatic colorectal cancer. Ann Oncol 20:1223–1229

    Article  PubMed  CAS  Google Scholar 

  79. Nagasue N, Yukaya H, Ogawa Y, Higashi T (1983) Portal pressure following partial to extensive hepatic resection in patients with and without cirrhosis of the liver. Ann Chir Gynaecol 72:18–22

    PubMed  CAS  Google Scholar 

  80. Hermanek P, Wittekind C (1994) Residual tumor (R) classification and prognosis. Semin Surg Oncol 10:12–20

    Article  PubMed  CAS  Google Scholar 

  81. Scheithauer W, Rosen H, Kornek GV, Sebesta C, Depisch D (1993) Randomised comparison of combination chemotherapy plus supportive care with supportive care alone in patients with metastatic colorectal cancer. BMJ 306:752–755

    Article  PubMed  CAS  Google Scholar 

  82. Best L, Simmonds P, Baughan C, Buchanan R, Davis C, Fentiman I, George S, Gosney M, Northover J, Williams C, Collaboration Colorectal Meta-analysis (2000) Palliative chemotherapy for advanced or metastatic colorectal cancer. Cochrane Database Syst Rev, CD001545

    Google Scholar 

  83. Saltz LB, Cox JV, Blanke C, Rosen LS, Fehrenbacher L, Moore MJ et al (2000) Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med 343:905–914

    Article  PubMed  CAS  Google Scholar 

  84. de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J et al (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18:2938–2947

    PubMed  Google Scholar 

  85. Goldberg RM, Sargent DJ, Morton RF, Fuchs CS, Ramanathan RK, Williamson SK et al (2004) A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 22:23–30

    Article  PubMed  CAS  Google Scholar 

  86. Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 350:2335–2342

    Article  PubMed  CAS  Google Scholar 

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Acknowledgement

Adrian M. Fox was supported by an educational grant from Sanofi-Aventis pharmaceuticals.

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  1. University Health Network, University of Toronto, Toronto, ON, Canada

    Adrian M. Fox

  2. University Health Network, University of Toronto, Toronto, ON, Canada

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    Pnina Brodt

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Fox, A.M., Gallinger, S., Moulton, CA. (2011). Colorectal Carcinoma Liver Metastasis: Surgical Clinical Perspective. In: Brodt, P. (eds) Liver Metastasis: Biology and Clinical Management. Cancer Metastasis - Biology and Treatment, vol 16. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0292-9_12

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