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Curable metastatic colorectal cancer: Recommended paradigms

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Abstract

“Cure” for patients with stage IV colorectal cancer remains elusive, but for a growing subset of patients with colorectal liver metastases (CLMs), cure (ie, > 10-year survival without evidence of disease) is achieved in at least 17% of resected patients. Candidates for resection include those with limited and in some cases extensive hepatic disease, and in highly selected cases, patients with extrahepatic disease. Number, size, and bilaterality of CLMs no longer stand as absolute contraindications to surgery. Chemotherapy has further advanced the field of surgery for CLMs, enabling an additional group of patients who present with unresectable disease to undergo surgery after downsizing with chemotherapy. Modern surgical techniques and liver preparation allow resection after chemotherapy, with excellent results. This article summarizes the current multidisciplinary approach to treatment of CLMs. The definition of resectability, conversion of unresectable CLMs to resectable ones, advances in surgical techniques, advances in chemotherapy, and predictors of outcome are detailed

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References and Recommended Reading

  1. Abdalla EK, Vauthey JN, Ellis LM, et al.: Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004, 239:818–825.

    Article  PubMed  Google Scholar 

  2. Aloia TA, Vauthey JN, Loyer EM, et al.: Solitary colorectal liver metastasis: resection determines outcome. Arch Surg 2006, 141:460–467.

    Article  PubMed  Google Scholar 

  3. Choti MA, Sitzmann JV, Tiburi MF, et al.: Trends in longterm survival following liver resection for hepatic colorectal metastases. Ann Surg 2002, 235:759–766.

    Article  PubMed  Google Scholar 

  4. Pawlik TM, Scoggins CR, Zorzi D, et al.: Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 2005, 241:715–724.

    Article  PubMed  Google Scholar 

  5. Strasberg SM, Dehdashti F, Siegel BA, et al.: Survival of patients evaluated by FDG-PET before hepatic resection for metastatic colorectal carcinoma: a prospective database study. Ann Surg 2001, 233:293–299.

    Article  PubMed  CAS  Google Scholar 

  6. Tomlinson JS, Jarnagin WR, DeMatteo RP, et al.: Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 2007, 25:4575–4580.

    Article  PubMed  Google Scholar 

  7. Hurwitz H, Fehrenbacher L, Novotny W, et al.: Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 2004, 350:2335–2342.

    Article  PubMed  CAS  Google Scholar 

  8. Tournigand C, Andre T, Achille E, et al.: FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 2004, 22:229–237.

    Article  PubMed  CAS  Google Scholar 

  9. Altendorf-Hofmann A, Scheele J: A critical review of the major indicators of prognosis after resection of hepatic metastases from colorectal carcinoma. Surg Oncol Clin N Am 2003, 12:165–192, xi.

    Article  PubMed  Google Scholar 

  10. Charnsangavej C, Clary B, Fong Y, et al.: Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 2006, 13:1261–1268.

    Article  PubMed  Google Scholar 

  11. Chun YS, Vauthey JN, Ribero D, et al.: Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival. J Gastrointest Surg 2007, 11:1498–1504.

    Article  PubMed  Google Scholar 

  12. Abdalla EK, Adam R, Bilchik AJ, et al.: Improving resectability of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 2006, 13:1271–1280.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  14. Vauthey JN, Chaoui A, Do KA, et al.: Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery 2000, 127:512–529.

    Article  PubMed  CAS  Google Scholar 

  15. Vauthey JN, Pawlik TM, Abdalla EK, et al.: Is extended hepatectomy for hepatobiliary malignancy justified? Ann Surg 2004, 239:722–732.

    Article  PubMed  Google Scholar 

  16. Johnson TN, Tucker GT, Tanner MS, Rostami-Hodjegan A: Changes in liver volume from birth to adulthood: a meta-analysis. Liver Transpl 2005, 11:1481–1493.

    Article  PubMed  Google Scholar 

  17. Abdalla EK, Barnett CC, Doherty D, et al.: Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 2002, 137:675–680.

    Article  PubMed  Google Scholar 

  18. Ribero D, Abdalla EK, Madoff DC, et al.: Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg 2007, 94:1386–1394.

    Article  PubMed  CAS  Google Scholar 

  19. Vauthey JN, Palavecino M, Curley SA, Abdalla EK: Right hepatic trisectionectomy for hepatobiliary disease: results and an appraisal of its current role. Ann Surg 2008, 248:138–139; author reply 139–140.

    Article  PubMed  Google Scholar 

  20. Azoulay D, Castaing D, Smail A, et al.: Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg 2000, 231:480–486.

    Article  PubMed  CAS  Google Scholar 

  21. Curley SA, Marra P, Beaty K, et al.: Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients. Ann Surg 2004, 239:450–458.

    Article  PubMed  Google Scholar 

  22. Zorzi D, Mullen JT, Abdalla EK, et al.: Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. J Gastrointest Surg 2006, 10:86–94.

    Article  PubMed  Google Scholar 

  23. Yan TD, Sim J, Black D, et al.: Systematic review on safety and efficacy of repeat hepatectomy for recurrent liver metastases from colorectal carcinoma. Ann Surg Oncol 2007, 14:2069–2077.

    Article  PubMed  Google Scholar 

  24. Aloia TA, Zorzi D, Abdalla EK, Vauthey JN: Two-surgeon technique for hepatic parenchymal transection of the noncirrhotic liver using saline-linked cautery and ultrasonic dissection. Ann Surg 2005, 242:172–177.

    Article  PubMed  Google Scholar 

  25. Belghiti J, Guevara OA, Noun R, et al.: Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg 2001, 193:109–111.

    Article  PubMed  CAS  Google Scholar 

  26. Chun YS, Abdalla EK, Zorzi D, et al.: Liver hanging maneuver improves the outcomes of complex right upper quadrant resections [abstract]. HPB Surg 2008, 9:AB–314.

    Google Scholar 

  27. Adam R, Delvart V, Pascal G, et al.: Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 2004, 240:644–657.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  29. Nordlinger B, Sorbye H, Glimelius B, 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, 371:1007–1016.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  31. Fernandez FG, Ritter J, Goodwin JW, et al.: Effect of steatohepatitis associated with irinotecan or oxaliplatin pretreatment on resectability of hepatic colorectal metastases. J Am Coll Surg 2005, 200:845–853.

    Article  PubMed  Google Scholar 

  32. Nakano H, Oussoultzoglou E, Rosso E, et al.: Sinusoidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy. Ann Surg 2008, 247:118–124.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  34. Rubbia-Brandt L, Audard V, Sartoretti P, et al.: Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol 2004, 15:460–466.

    Article  PubMed  CAS  Google Scholar 

  35. Aloia T, Sebagh M, Plasse M, et al.: Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases. J Clin Oncol 2006, 24:4983–4990.

    Article  PubMed  CAS  Google Scholar 

  36. Karoui M, Penna C, Amin-Hashem M, et al.: Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 2006, 243:1–7.

    Article  PubMed  Google Scholar 

  37. Parikh AA, Gentner B, Wu TT, et al.: Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy. J Gastrointest Surg 2003, 7:1082–1088.

    Article  PubMed  Google Scholar 

  38. Scappaticci FA, Fehrenbacher L, Cartwright T, et al.: Surgical wound healing complications in metastatic colorectal cancer patients treated with bevacizumab. J Surg Oncol 2005, 91:173–180.

    Article  PubMed  CAS  Google Scholar 

  39. D’Angelica M, Kornprat P, Gonen M, et al.: Lack of evidence for increased operative morbidity after hepatectomy with perioperative use of bevacizumab: a matched case-control study. Ann Surg Oncol 2007, 14:759–765.

    Article  PubMed  Google Scholar 

  40. Benoist S, Brouquet A, Penna C, et al.: Complete response of colorectal liver metastases after chemotherapy: does it mean cure? J Clin Oncol 2006, 24:3939–3945.

    Article  PubMed  Google Scholar 

  41. Tan MC, Linehan DC, Hawkins WG, et al.: Chemotherapy-induced normalization of FDG uptake by colorectal liver metastases does not usually indicate complete pathologic response. J Gastrointest Surg 2007, 11:1112–1119.

    Article  PubMed  Google Scholar 

  42. Adam R, Wicherts DA, de Haas RJ, et al.: Complete pathologic response after preoperative chemotherapy for colorectal liver metastases: myth or reality? J Clin Oncol 2008, 26:1635–1641.

    Article  PubMed  Google Scholar 

  43. Blazer DG 3rd, Kishi Y, Maru DM, et al.: Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases. J Clin Oncol 2008, 26:5344–5351.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Suite 12.2016, Houston, TX, 77030, USA

    Eddie K. Abdalla

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  1. Richard N. Berri
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  2. Eddie K. Abdalla
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Correspondence to Eddie K. Abdalla.

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Berri, R.N., Abdalla, E.K. Curable metastatic colorectal cancer: Recommended paradigms. Curr Oncol Rep 11, 200–208 (2009). https://doi.org/10.1007/s11912-009-0029-z

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  • DOI: https://doi.org/10.1007/s11912-009-0029-z

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