Skip to main content
SpringerLink
Log in

Colorectal Liver Metastases

  • Chapter
  • First Online:
Book cover Surgical Oncology Manual

Abstract

Resection of colorectal liver metastases (CRLM) improves survival compared with systemic therapy alone. Technical resectability requires preservation of adequate functional liver remnant with biliary drainage, vascular inflow and outflow. Assessment for resectability should be predicated on high-quality cross-sectional imaging. Systemic therapy is an essential part of treating CRLM; sequence of treatment should be discussed in a multidisciplinary setting, particularly in the setting of synchronous disease. Ablative strategies (radiofrequency or microwave) should be considered in patients with otherwise unresectable disease in whom all lesions can be treated. Evolving techniques for unresectable CRLM include associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), hepatic artery infusion pump chemotherapy, drug-eluting beads with irinotecan, irreversible electroporation (IRE), transplantation, and yttrium-90. Given the increasing options and possible treatment permutations, all patients with liver predominant colorectal metastases should be discussed in a multidisciplinary setting including hepatobiliary surgeons.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Galandiuk S, et al. Patterns of recurrence after curative resection of carcinoma of the colon and rectum. Surg Gynecol Obstet. 1992;174(1):27–32.

    CAS  PubMed  Google Scholar 

  2. Minagawa M, et al. Selection criteria for simultaneous resection in patients with synchronous liver metastasis. Arch Surg. 2006;141(10):1006–12.

    Article  PubMed  Google Scholar 

  3. Manfredi S, et al. Epidemiology and management of liver metastases from colorectal cancer. Ann Surg. 2006;244(2):254–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Adam R, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240(4):644–57. discussion 657–8.

    PubMed  PubMed Central  Google Scholar 

  5. Beppu T, et al. Chemotherapy and targeted therapy for patients with initially unresectable colorectal liver metastases, focusing on conversion hepatectomy and long-term survival. Ann Surg Oncol. 2014;21 Suppl 3:S405–13.

    Article  PubMed  Google Scholar 

  6. Pulitano C, et al. Liver resection for colorectal metastases in presence of extrahepatic disease: results from an international multi-institutional analysis. Ann Surg Oncol. 2011;18(5):1380–8.

    Article  PubMed  Google Scholar 

  7. Wicherts DA, et al. Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Ann Surg. 2008;248(6):994–1005.

    Article  PubMed  Google Scholar 

  8. Wei AC, et al. Survival after hepatic resection for colorectal metastases: a 10-year experience. Ann Surg Oncol. 2006;13(5):668–76.

    Article  PubMed  Google Scholar 

  9. Tomlinson JS, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25(29):4575–80.

    Article  PubMed  Google Scholar 

  10. Giuliante F, et al. Role of the surgeon as a variable in long-term survival after liver resection for colorectal metastases. J Surg Oncol. 2009;100(7):538–45.

    Article  PubMed  Google Scholar 

  11. Nordlinger B, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer. 1996;77(7):1254–62.

    Article  CAS  PubMed  Google Scholar 

  12. Fong Y, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230(3):309–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Adams RB, et al. Selection for hepatic resection of colorectal liver metastases: expert consensus statement. HPB (Oxford). 2013;15(2):91–103.

    Article  PubMed Central  Google Scholar 

  14. Schiffman SC, et al. Laparoscopic versus open liver resection for metastatic colorectal cancer: a metaanalysis of 610 patients. Surgery. 2015;157:211–22.

    Article  PubMed  Google Scholar 

  15. Castaing D, et al. Oncologic results of laparoscopic versus open hepatectomy for colorectal liver metastases in two specialized centers. Ann Surg. 2009;250(5):849–55.

    Article  PubMed  Google Scholar 

  16. Nguyen KT, et al. Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes. Ann Surg. 2009;250(5):842–8.

    Article  PubMed  Google Scholar 

  17. Gold JS, et al. Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg. 2008;247(1):109–17.

    Article  PubMed  Google Scholar 

  18. Sarpel U, et al. Does anatomic versus nonanatomic resection affect recurrence and survival in patients undergoing surgery for colorectal liver metastasis? Ann Surg Oncol. 2009;16(2):379–84.

    Article  PubMed  Google Scholar 

  19. de Rosa A, et al. Stage IV colorectal cancer: outcomes following the liver-first approach. J Surg Oncol. 2013;108(7):444–9.

    Article  PubMed  Google Scholar 

  20. Wang SC, D’Angelica MI. Chemotherapy-associated hepatotoxicity and hepatic resection for metastatic colorectal cancer. Curr Colorectal Cancer Rep. 2014;10(2):195–203.

    Article  Google Scholar 

  21. Lee SJ, et al. Survival benefit from ovarian metastatectomy in colorectal cancer patients with ovarian metastasis: a retrospective analysis. Cancer Chemother Pharmacol. 2010;66(2):229–35.

    Article  PubMed  Google Scholar 

  22. Huang PP, et al. Long-term survival in patients with ovarian metastases from colorectal carcinoma. Ann Surg Oncol. 1998;5(8):695–8.

    Article  CAS  PubMed  Google Scholar 

  23. Gallinger S, et al. Liver resection for colorectal cancer metastases. Curr Oncol. 2013;20(3):e255–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Karanicolas PJ, et al. Long-term outcomes following tumor ablation for treatment of bilateral colorectal liver metastases. JAMA Surg. 2013;148(7):597–601.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Correa-Gallego C, et al. A retrospective comparison of microwave ablation vs. radiofrequency ablation for colorectal cancer hepatic metastases. Ann Surg Oncol. 2014;21:4278–83.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Schnitzbauer AA, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012;255(3):405–14.

    Article  PubMed  Google Scholar 

  27. Oldhafer KJ, et al. ALPPS for patients with colorectal liver metastases: effective liver hypertrophy, but early tumor recurrence. World J Surg. 2014;38(6):1504–9.

    Article  PubMed  Google Scholar 

  28. Schadde E, et al. ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: results of a multicenter analysis. World J Surg. 2014;38(6):1510–9.

    Article  PubMed  Google Scholar 

  29. Hernandez-Alejandro R, et al. Can we improve the morbidity and mortality associated with the associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) procedure in the management of colorectal liver metastases? Surgery. 2015;157:194–201.

    Article  PubMed  Google Scholar 

  30. Goere D, et al. Prolonged survival of initially unresectable hepatic colorectal cancer patients treated with hepatic arterial infusion of oxaliplatin followed by radical surgery of metastases. Ann Surg. 2010;251(4):686–91.

    Article  PubMed  Google Scholar 

  31. Ammori JB, et al. Conversion to complete resection and/or ablation using hepatic artery infusional chemotherapy in patients with unresectable liver metastases from colorectal cancer: a decade of experience at a single institution. Ann Surg Oncol. 2013;20(9):2901–7.

    Article  PubMed  Google Scholar 

  32. D’Angelica MI, et al. Phase II trial of hepatic artery infusional and systemic chemotherapy for patients with unresectable hepatic metastases from colorectal cancer: conversion to resection and long-term outcomes. Ann Surg. 2015;261:353–60.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Karanicolas PJ, et al. Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement. Curr Oncol. 2014;21(1):e129–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Richardson AJ, Laurence JM, Lam VW. Transarterial chemoembolization with irinotecan beads in the treatment of colorectal liver metastases: systematic review. J Vasc Interv Radiol. 2013;24(8):1209–17.

    Article  PubMed  Google Scholar 

  35. Fiorentini G, et al. Intra-arterial infusion of irinotecan-loaded drug-eluting beads (DEBIRI) versus intravenous therapy (FOLFIRI) for hepatic metastases from colorectal cancer: final results of a phase III study. Anticancer Res. 2012;32(4):1387–95.

    CAS  PubMed  Google Scholar 

  36. Comito T, et al. Stereotactic Ablative Radiotherapy (SABR) in inoperable oligometastatic disease from colorectal cancer: a safe and effective approach. BMC Cancer. 2014;14:619.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hagness M, et al. Liver transplantation for nonresectable liver metastases from colorectal cancer. Ann Surg. 2013;257(5):800–6.

    Article  PubMed  Google Scholar 

  38. Dueland S, et al. Chemotherapy or liver transplantation for nonresectable liver metastases from colorectal cancer? Ann Surg. 2015;261:956–60.

    Article  PubMed  Google Scholar 

  39. Dueland S, et al. Is liver transplantation an option in colorectal cancer patients with nonresectable liver metastases and progression on all lines of standard chemotherapy? Ann Surg Oncol. 2015;22:2195–200.

    Article  PubMed  Google Scholar 

  40. Saxena A, et al. A systematic review on the safety and efficacy of yttrium-90 radioembolization for unresectable, chemorefractory colorectal cancer liver metastases. J Cancer Res Clin Oncol. 2014;140(4):537–47.

    Article  CAS  PubMed  Google Scholar 

  41. Chua HK, et al. Concurrent vs. staged colectomy and hepatectomy for primary colorectal cancer with synchronous hepatic metastases. Dis Colon Rectum. 2004;47(8):1310–6.

    Article  PubMed  Google Scholar 

  42. Reddy SK, et al. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol. 2007;14(12):3481–91.

    Article  PubMed  Google Scholar 

  43. Martin R, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg. 2003;197(2):233–41.

    Article  PubMed  Google Scholar 

  44. Jaeck D, et al. 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. 2004;240(6):1037–49.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Nordlinger 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(9617):1007–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Nordlinger B, et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013;14(12):1208–15.

    Article  CAS  PubMed  Google Scholar 

  47. Folprecht G, et al. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial. Lancet Oncol. 2010;11(1):38–47.

    Article  CAS  PubMed  Google Scholar 

  48. Wong R, et al. A multicentre study of capecitabine, oxaliplatin plus bevacizumab as perioperative treatment of patients with poor-risk colorectal liver-only metastases not selected for upfront resection. Ann Oncol. 2011;22(9):2042–8.

    Article  CAS  PubMed  Google Scholar 

  49. Shah SA, et al. Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma. J Am Coll Surg. 2006;202(3):468–75.

    Article  PubMed  Google Scholar 

  50. Adam R, et al. Is hepatic resection justified after chemotherapy in patients with colorectal liver metastases and lymph node involvement? J Clin Oncol. 2008;26(22):3672–80.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Fellow, General Surgical Oncology, University of Toronto, Toronto, ON, Canada

    Melanie E. Tsang M.D., M.Sc., F.R.C.S.C.

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Shiva Jayaraman MD,MESc,FRCSC,FACS, Paul J. Karanicolas M.D., Ph.D., F.R.C.S.C. & Alice C. Wei MD,MSc,FRCSC,FACS

Authors
  1. Melanie E. Tsang M.D., M.Sc., F.R.C.S.C.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shiva Jayaraman MD,MESc,FRCSC,FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul J. Karanicolas M.D., Ph.D., F.R.C.S.C.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alice C. Wei MD,MSc,FRCSC,FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Melanie E. Tsang M.D., M.Sc., F.R.C.S.C. .

Editor information

Editors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    Frances C. Wright

  2. Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    Jaime Escallon

  3. Department of Surgical Oncology, National Cancer Institute, Panama City, Panama

    Moises Cukier

  4. General Surgical Oncology, University of Toronto, 1X5, Ontario, Canada

    Melanie E. Tsang

  5. General Surgical Oncology, University of Toronto, Toronto, Ontario, Canada

    Usmaan Hameed

Rights and permissions

Reprints and permissions

Copyright information

© 2016 University of Toronto General Surgery Oncology Program

About this chapter

Cite this chapter

Tsang, M.E., Jayaraman, S., Karanicolas, P.J., Wei, A.C. (2016). Colorectal Liver Metastases. In: Wright, F., Escallon, J., Cukier, M., Tsang, M., Hameed, U. (eds) Surgical Oncology Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-26276-5_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-26276-5_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-26274-1

  • Online ISBN: 978-3-319-26276-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation