Advertisement

Diagnosis and Treatment of Liver Metastases

  • Antoine Brouquet
  • Bernard Nordlinger
Chapter

Abstract

Colorectal cancer is one of the leading causes of cancer death worldwide and in Asia. The most frequent cause of death in patients with colorectal cancer is due to liver metastases. Liver metastases can be detected at the time of diagnosis of the primary tumor (synchronous liver metastases) or during the follow-up of a patient treated for a colorectal cancer (metachronous liver metastases). Early detection by imaging of colorectal liver metastases is needed since liver resection allows prolonged survival in a subset of patients with resectable liver metastases (10–15 % of patients with colorectal liver metastases). After resection, 5-year survival rate can approach 50 % of the patients. Recurrences after liver resection for colorectal occur in nearly half of the patient. Objectives in the future for the treatment of colorectal liver metastases should be to increase the resectability rate and to decrease the recurrence rate after curative liver resection. Multimodality treatment including combined strategy could lead to improve oncologic results of surgery for colorectal liver metastases.

Keywords

Liver Metastasis Liver Resection Hepatic Resection Preoperative Chemotherapy Colorectal Liver Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics. CA Cancer J Clin. 2009;59:225–49.Google Scholar
  2. 2.
    Stangl R, Altendorf-Hofmann A, Charnley RM, Scheele J. Factors influencing the natural history of colorectal liver metastases. Lancet. 1994;343:1405–10.CrossRefPubMedGoogle Scholar
  3. 3.
    Scheele J. Hepatectomy for liver metastases. Br J Surg. 1993;80:274–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 2000;191:38–46.CrossRefPubMedGoogle Scholar
  5. 5.
    Bipat S, van Leeuwen MS, Comans EF, et al. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis – meta-analysis. Radiology. 2005;237:123–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Truant S, Huglo D, Hebbar M, Ernst O, Steinling M, Pruvot FR. Prospective evaluation of the impact of [18F]fluoro-2-deoxy-D-glucose positron emission tomography of resectable colorectal liver metastases. Br J Surg. 2005;92:362–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–18.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Nordlinger B, Jaeck D, Guiguet M, Vaillant JC, Balladur P, Schaal JC. Surgical resection of hepatic metastases. Multicentric retrospective study by the French Association of Surgery. In: Nordlinger B, Jaeck D, editors. Treatment of hepatic metastases of colorectal cancer. Paris: Springer; 1992. p. 129–46.CrossRefGoogle Scholar
  9. 9.
    Nordlinger B, Guiguet M, Vaillant J-C, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Cancer. 1996;77:1254–62.CrossRefPubMedGoogle Scholar
  10. 10.
    Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A, Eng C, Curley SA, Loyer EM, Muratore A, Mentha G, Capussotti L, Vauthey JN. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241:715–22.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Bodingbauer M, Tamandl D, Schmid K, Plank C, Schima W, Gruenberger T. Size of surgical margin does not influence recurrence rates after curative liver resection for colorectal cancer liver metastases. Br J Surg. 2007;94:1133–8.CrossRefPubMedGoogle Scholar
  12. 12.
    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;15:460–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Fernandez FG, Ritter J, Goodwin JW, Linehan DC, Hawkins WG, Strasberg SM. Effect of steatohepatitis associated with irinotecan or oxaliplatin pretreatment on resectability of hepatic colorectal metastases. J Am Coll Surg. 2005;200:845–53.CrossRefPubMedGoogle Scholar
  14. 14.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    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;24:2065–72.CrossRefPubMedGoogle Scholar
  16. 16.
    Brouquet A, Benoist S, Julie C, Penna C, Beauchet A, Rougier P, Nordlinger B. Risk factors for chemotherapy-associated liver injuries: a multivariate analysis of a group of 146 patients with colorectal metastases. Surgery. 2009;145:362–71.CrossRefPubMedGoogle Scholar
  17. 17.
    Finch RJ, Malik HZ, Hamady ZZ, Al-Mukhtar A, Adair R, Prasad KR, Lodge JP, Toogood GJ. Effect of type of resection on outcome of hepatic resection for colorectal metastases. Br J Surg. 2007;94:1242–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Scheele J, Stang R, Altendorf-Hofmann A, et al. Resection of colorectal metastases. World J Surg. 1995;191:59–71.CrossRefGoogle Scholar
  19. 19.
    Chun YS, Vauthey JN. Extending the frontiers of resectability in advanced colorectal cancer. Eur J Surg Oncol. 2007;33:S52–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Rivoire M, De Cian F, Meeus P, Négrier S, Sebban H, Kaemmerlen P. Combination of neoadjuvant chemotherapy with cryotherapy and surgical resection for the treatment of unresectable liver metastases from colorectal carcinoma. Cancer. 2002;95:2283–92.CrossRefPubMedGoogle Scholar
  21. 21.
    Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, Hess K, Curley SA. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239:818–25.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Berber E, Siperstein A. Local recurrence after laparoscopic radiofrequency ablation of liver tumors: an analysis of 1032 tumors. Ann Surg Oncol. 2008;15:2757–64.CrossRefPubMedGoogle Scholar
  23. 23.
    Azoulay D, Castaing D, Smail A, Adam R, Cailliez V, Laurent A, Lemoine A, Bismuth H. Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg. 2000;231:480–6.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Elias D, De Baere T, Roche A, Mducreux, Leclere J, Lasser P. During liver regeneration following right portal embolization the growth rate of liver metastases is more rapid than that of the liver parenchyma. Br J Surg. 1999;86:784–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Goéré D, Farges O, Leporrier J, Sauvanet A, Vilgrain V, Belghiti J. Chemotherapy does not impair hypertrophy of the left liver after right portal vein obstruction. J Gastrointest Surg. 2006;10:365–70.CrossRefPubMedGoogle Scholar
  26. 26.
    Beal IK, Anthony S, Papadopoulou A, Hutchins R, Fusai G, Begent R, Davies N, Tibballs J, Davidson B. Portal vein embolisation prior to hepatic resection for colorectal liver metastases and the effects of periprocedure chemotherapy. Br J Radiol. 2006;79:473–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Brouquet A, Belghiti J. Chemotherapy and its effect on liver hypertrophy: implications for portal vein embolization and resection. Semin Interv Radiol. 2008;25:162–6.CrossRefGoogle Scholar
  28. 28.
    Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber JC, Bachellier P. 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;240:1037–49.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Nordlinger B, Vaillant JC, Guiguet M, Balladur P, Paris F, Bachellier P, Jaeck D. Survival benefit of repeat liver resections for recurrent colorectal metastases: 143 cases. Association Francaise de Chirurgie. J Clin Oncol. 1994;12:1491–6.PubMedGoogle Scholar
  30. 30.
    Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, Bechstein WO, Primrose JN, Walpole ET, Finch-Jones M, Jaeck D, Mirza D, Parks RW, Collette L, Praet M, Bethe U, Van Cutsem E, Scheithauer W, Gruenberger T. 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;371:1007–16.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, Boni C, Cortes-Funes H, Cervantes A, Freyer G, Papamichael D, Le Bail N, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18:2938–47.PubMedGoogle Scholar
  32. 32.
    Douillard JY, Cunningham D, Roth AD, Navarro M, James RD, Karasek P, Jandik P, Iveson T, Carmichael J, Alakl M, Gruia G, Awad L, et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomized trial. Lancet. 2000;355:1041–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Falcone A, Ricci S, Brunetti I, Pfanner E, Allegrini G, Barbara C, Crinò L, Benedetti G, Evangelista W, Fanchini L, Cortesi E, Picone V, et al. Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest. J Clin Oncol. 2007;25:1670–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Cunningham D, Humblet Y, Siena S, Khayat D, Bleiberg H, Santoro A, Bets D, Mueser M, Harstrick A, Verslype C, Chau I, Van Cutsem E. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med. 2004;351:337–45.CrossRefPubMedGoogle Scholar
  35. 35.
    Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, Berlin J, Baron A, Griffing S, Holmgren E, Ferrara N, Fyfe G, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350:2335–42.CrossRefPubMedGoogle Scholar
  36. 36.
    Van Cutsem E, Köhne CH, Hitre E, Zaluski J, Chang Chien CR, Makhson A, D'Haens G, Pintér T, Lim R, Bodoky G, Roh JK, et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med. 2009;360:1408–17.CrossRefPubMedGoogle Scholar
  37. 37.
    Meric F, Patt YZ, Curley SA, Chase J, Roh MS, Vauthey JN, Ellis LM. Surgery after downstaging of unresectable hepatic tumors with intra-arterial chemotherapy. Ann Surg Oncol. 2000;7:490–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, Giacchetti S, Paule B, Kunstlinger F, Ghémard O, Levi F, Bismuth H. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Adam R, Pascal G, Castaing D, Azoulay D, Delvart V, Paule B, Levi F, Bismuth H. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg. 2004;240:1052–61.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Rubbia-Brandt L, Giostra E, Brezault C, Roth AD, Andres A, Audard V, Sartoretti P, Dousset B, Majno PE, Soubrane O, Chaussade S, Mentha G, Terris B. Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery. Ann Oncol. 2007;18:299–304.CrossRefPubMedGoogle Scholar
  41. 41.
    Allen PJ, Kemeny N, Jarnagin W, DeMatteo R, Blumgart L, Fong Y. Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases. J Gastrointest Surg. 2003;7:109–15.CrossRefPubMedGoogle Scholar
  42. 42.
    Blazer 3rd DG, Kishi Y, Maru DM, Kopetz S, Chun YS, Overman MJ, Fogelman D, Eng C, Chang DZ, Wang H, Zorzi D, Ribero D, Ellis LM, Glover KY, Wolff RA, Curley SA, Abdalla EK, Vauthey JN. Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases. J Clin Oncol. 2008;26:5344–51.CrossRefPubMedGoogle Scholar
  43. 43.
    Lorenz M, Muller HH, Schramm H, et al. Randomized trial of surgery versus surgery followed by adjuvant hepatic arterial infusion with 5-fluorouracil and folinic acid for liver metastases of colorectal cancer. German Cooperative on Liver Metastases. Ann Surg. 1998;228:756–62.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Kemeny N, Huang Y, Cohen AM, et al. Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med. 1999;341:2039–48.CrossRefPubMedGoogle Scholar
  45. 45.
    Kemeny MM, Adak S, Gray B, et al. Combined-modality treatment for resectable metastatic colorectal carcinoma to the liver: surgical resection of hepatic metastases in combination with continuous infusion of chemotherapy-an intergroup study. J Clin Oncol. 2002;20:1499–505.CrossRefPubMedGoogle Scholar
  46. 46.
    Portier G, Elias D, Bouche O, et al. Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases: FFCD ACHBTH AURC 9002 trial. J Clin Oncol. 2006;24:4976–82.CrossRefPubMedGoogle Scholar
  47. 47.
    Langer B, Bleiberg H, Labianca R. Fluorouracil (FU) plus l-leucovorin (l-LV) versus observation after potentially curative resection of liver or lung metastases from colorectal cancer (CRC): results of the ENG (EORTC/NCIC CTG/GIVIO) randomized trial. J Clin Oncol. 2002;20:149a (abstr 592).Google Scholar
  48. 48.
    Mitry E, Fields A, Bleiberg H, et al. Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer. A meta-analysis of two randomized trials. J Clin Oncol. 2006;24(18S):3524.Google Scholar
  49. 49.
    Benoist S, Pautrat K, Mitry E, Rougier P, Penna C, Nordlinger B. Treatment strategy for patients with colorectal cancer and synchronous irresectable liver metastases. Br J Surg. 2005;92:1155–60.CrossRefPubMedGoogle Scholar
  50. 50.
    Mentha G, Majno PE, Andres A, Rubbia-Brandt L, Morel P, Roth AD. Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg. 2006;93:872–8.CrossRefPubMedGoogle Scholar
  51. 51.
    Bretagnol F, Hatwell C, Farges O, Alves A, Belghiti J, Panis Y. Benefit of laparoscopy for rectal resection in patients operated simultaneously for synchronous liver metastases: preliminary experience. Surgery. 2008;144:436–41.CrossRefPubMedGoogle Scholar
  52. 52.
    Martin 2nd RC, Augenstein V, Reuter NP, Scoggins CR, McMasters KM. Simultaneous versus staged resection for synchronous colorectal cancer liver metastases. J Am Coll Surg. 2009;208:842–50.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht and People's Medical Publishing House 2017

Authors and Affiliations

  1. 1.Department of Digestive and Oncologic SurgeryAmbroise Paré Hospital BoulogneBoulogne CedexFrance

Personalised recommendations