Hepatic metastasis

Abstract

Colorectal cancer is the third most common cancer in the world. About 30–50% of the patients with colorectal cancer would develop liver metastasis in the course of their illness. About one-third of the metastatic liver lesions (CRM) are considered to be resectable, and long-term cure is not infrequently observed. Advances in the surgical management of CRM have certainly improved the chance of resection in recent years. While the selection criteria for open resection is becoming well established in most centers globally, the introduction of laparoscopy to liver resection has shown to be safe and feasible in many recent reported series. The controversy around the optimal approach for synchronous CRM remains unresolved, but the inception of laparoscopic liver surgery has favored the approach with simultaneous resections, especially when left lateral sectionectomy or other minor liver resections are required. On the other hand, various approaches have been proposed to improve the resectability rate for bilobar CRM. A two-stage hepatectomy was associated with a 5-year overall survival rate of up to 30–40%. Alternatively, the recently popularized ALPPS procedure conferred a 2-year overall survival rate of over 50%. For unresectable bilobar CRM, liver transplantation has been proposed to be an effective treatment under stringent selection criteria that, in turn, offered a 5-year overall survival rate up to 60%. A randomized control trial to compare its efficacy with resection is currently underway, and the outcome of this study will be of significance to ascertain its role in the surgical management of CRM.