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Surgical and Ablative Management of Liver Metastases

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Rectal Cancer

Part of the book series: Current Clinical Oncology ((CCO))

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Abstract

Colorectal liver metastases (CRLM) develop within 5 years of primary tumor diagnosis in up to 50% of patients and are diagnosed on preoperative imaging or at primary tumor resection in 15–25% of patients. Modern criteria for resectability of CLRM emphasize the ability to achieve (1) a negative hepatic resection margin; (2) a future liver remnant of at least two contiguous segments with intact biliary drainage, vascular inflow/outflow, and adequate size to provide sufficient hepatic function after resection; and (3) the ability to completely resect and/or ablate extrahepatic disease (EHD). Recent studies have shown that the inability to achieve a 1-cm negative resection margin or the presence of resectable EHD is no longer contraindications to resection. Oxaliplatin and irinotecan-based chemotherapy may serve to both augment the resectability of CRLM by shrinking previously unresectable lesions and render disease unresectable via injury to the nontumor bearing liver. Portal vein embolization (PVO) has been employed to broaden the criteria for resectability by increasing the volume and synthetic function of the future liver remnant. Two-stage hepatectomy is an effective resection strategy for select patients with multiple bilateral colorectal liver metastases that would otherwise be unresectable. Prospective trials and retrospective studies with extensive follow-up demonstrate long-term survival benefits after resection CRLM. Indications for radiofrequency ablation (RFA) include (1) unresectability of liver disease due to location, size, number, or patient comorbidity such that the hepatic reserve provided by the future liver remnant would not be sufficient for patient survival or (2) as an adjunct to hepatic resection to clear the liver remnant of disease while preserving liver function (Abdalla et al, Ann Surg Oncol 13:1271–1280, 2006). While RFA does not provide comparable long-term survival to that provided by resection, outcomes after RFA are superior to that after systemic chemotherapy alone. These developments underscore the need for the early involvement of hepatobiliary surgeons in the multidisciplinary care of patients with CRLM.

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Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, Duke University Medical Center, Durham, NC, USA

    Srinevas K. Reddy MD & Bryan M. Clary MD

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  1. Srinevas K. Reddy MD
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  2. Bryan M. Clary MD
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Editors and Affiliations

  1. Dept. Radiation Oncology, Duke University Medical Center, Durham, USA

    Brian G. Czito

  2. Dept. Radiation Oncology, Duke University Medical Center, Durham, USA

    Christopher G. Willett

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Reddy, S.K., Clary, B.M. (2010). Surgical and Ablative Management of Liver Metastases. In: Czito, B., Willett, C. (eds) Rectal Cancer. Current Clinical Oncology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-567-5_8

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