Preoperative selection of patients with colorectal cancer liver metastasis for hepatic resection

• Published in: World journal of gastroenterology : WJG Vol. 22; no. 2; pp. 567 - 581
• Main Authors: Mattar, Rafif E, Al-Alem, Faisal, Simoneau, Eve, Hassanain, Mazen
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 14.01.2016
• Subjects: Chemotherapy, Adjuvant; Colectomy; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Decision Support Techniques; Hepatectomy - adverse effects; Humans; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Metastasectomy - adverse effects; Metastasectomy - methods; Neoadjuvant Therapy; Patient Selection; Predictive Value of Tests; Risk Assessment; Risk Factors; Time-to-Treatment; Topic Highlight; Treatment Outcome; Preoperative selection; Colorectal cancer liver metastases; Liver resection; Patient selection; Hepatectomy
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v22.i2.567

Surgical resection of colorectal liver metastases (CRLM) has a well-documented improvement in survival. To benefit from this intervention, proper selection of patients who would be adequate surgical candidates becomes vital. A combination of imaging techniques may be utilized in the detection of the lesions. The criteria for resection are continuously evolving; currently, the requirements that need be met to undergo resection of CRLM are: the anticipation of attaining a negative margin (R0 resection), whilst maintaining an adequate functioning future liver remnant. The timing of hepatectomy in regards to resection of the primary remains controversial; before, after, or simultaneously. This depends mainly on the tumor burden and symptoms from the primary tumor. The role of chemotherapy differs according to the resectability of the liver lesion(s); no evidence of improved survival was shown in patients with resectable disease who received preoperative chemotherapy. Presence of extrahepatic disease in itself is no longer considered a reason to preclude patients from resection of their CRLM, providing limited extra-hepatic disease, although this currently is an area of active investigations. In conclusion, we review the indications, the adequate selection of patients and perioperative factors to be considered for resection of colorectal liver metastasis.