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Digestive Disease Interventions 2020; 04(01): 040-045
DOI: 10.1055/s-0040-1705102
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evolution of Surgical Management of Colorectal Liver Metastasis

Yuki Bekki
1   Department of Liver Surgery, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York
,
Daniel Bitner 
2   Division of General Surgery, Department of Surgery, Mount Sinai School of Medicine, New York
,
Ganesh Gunasekaran
1   Department of Liver Surgery, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York
› Author Affiliations
Further Information

Publication History

18 December 2019

10 January 2020

Publication Date:
06 March 2020 (online)

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Abstract

The treatment of colorectal liver metastasis (CRLM) has progressed markedly in the past decades. Main contributions stem from improvement in surgical approach and applications of chemotherapy. The availability of several perioperative and surgical techniques, including portal vein embolization, ablation techniques, and two-stage hepatectomies, has expanded surgical indications. In addition, preoperative imaging methods have contributed to these advances.

In patients with high oncological risk of recurrence, or initially unresectable CRLM, highly individualized treatment regimens are becoming more widely utilized. These patients should be evaluated for surgical resection after several cycles of chemotherapy given the survival benefit afforded by liver resection for CRLM. Several biomarkers, including RAS mutation, BRAF mutation, and microsatellite stability, have become essential in guiding therapy. Immunotherapy has recently been highlighted, especially for cases of microsatellite instability. Looking forward, biomarkers will likely to continue to guide individualized treatment patterns.

Liver transplantation as an option for patients with unresectable CRLM may boast comparable outcomes to patients with primary liver tumors, but it remains controversial considering the limited supply of donor livers.

Management of CRLM requires the complex decision making process common to contemporary tumor board discussions, and a multidisciplinary approach likely figures into future directions of management for CRLM.

Keywords

multidisciplinary team - colorectal - liver metastasis - overall survival
 

  • References

  • 1 Wagner JS, Adson MA, Van Heerden JA, Adson MH, Ilstrup DM. The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg 1984; 199 (05) 502-508
    CrossrefPubMedGoogle Scholar
  • 2 Nordlinger B, Sorbye H, Glimelius B. , et al; EORTC Gastro-Intestinal Tract Cancer Group; Cancer Research UK; Arbeitsgruppe Lebermetastasen und–tumoren in der Chirurgischen Arbeitsgemeinschaft Onkologie (ALM-CAO); Australasian Gastro-Intestinal Trials Group (AGITG); Fédération Francophone de Cancérologie Digestive (FFCD). 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) 1208-1215
    CrossrefPubMedGoogle Scholar
  • 3 Angelsen JH, Horn A, Sorbye H, Eide GE, Løes IM, Viste A. Population-based study on resection rates and survival in patients with colorectal liver metastasis in Norway. Br J Surg 2017; 104 (05) 580-589
    CrossrefPubMedGoogle Scholar
  • 4 Weledji EP. Centralization of liver cancer surgery and impact on multidisciplinary teams working on stage IV colorectal cancer. Oncol Rev 2017; 11 (02) 331
    PubMedGoogle Scholar
  • 5 Adam R, de Gramont A, Figueras J. , et al; of the EGOSLIM (Expert Group on OncoSurgery management of LIver Metastases) group. Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev 2015; 41 (09) 729-741
    CrossrefPubMedGoogle Scholar
  • 6 Lordan JT, Karanjia ND, Quiney N, Fawcett WJ, Worthington TR. A 10-year study of outcome following hepatic resection for colorectal liver metastases—the effect of evaluation in a multidisciplinary team setting. Eur J Surg Oncol 2009; 35 (03) 302-306
    CrossrefPubMedGoogle Scholar
  • 7 Segelman J, Singnomklao T, Hellborg H, Martling A. Differences in multidisciplinary team assessment and treatment between patients with stage IV colon and rectal cancer. Colorectal Dis 2009; 11 (07) 768-774
    CrossrefPubMedGoogle Scholar
  • 8 Ekberg H, Tranberg KG, Andersson R. , et al. Determinants of survival in liver resection for colorectal secondaries. Br J Surg 1986; 73 (09) 727-731
    CrossrefPubMedGoogle Scholar
  • 9 Charnsangavej C, Clary B, Fong Y, Grothey A, Pawlik TM, Choti MA. Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 2006; 13 (10) 1261-1268
    CrossrefPubMedGoogle Scholar
  • 10 Spolverato G, Ejaz A, Azad N, Pawlik TM. Surgery for colorectal liver metastases: the evolution of determining prognosis. World J Gastrointest Oncol 2013; 5 (12) 207-221
    PubMedGoogle Scholar
  • 11 Tzeng CW, Aloia TA. Colorectal liver metastases. J Gastrointest Surg 2013; 17 (01) 195-201 , quiz 201–202
    CrossrefPubMedGoogle Scholar
  • 12 Nordlinger B, Sorbye H, Glimelius B. , et al; EORTC Gastro-Intestinal Tract Cancer Group; Cancer Research UK; Arbeitsgruppe Lebermetastasen und-tumoren in der Chirurgischen Arbeitsgemeinschaft Onkologie (ALM-CAO); Australasian Gastro-Intestinal Trials Group (AGITG); Fédération Francophone de Cancérologie Digestive (FFCD). 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): 1007-1016
    CrossrefPubMedGoogle Scholar
  • 13 Oki E, Ando K, Nakanishi R. , et al. Recent advances in treatment for colorectal liver metastasis. Ann Gastroenterol Surg 2018; 2 (03) 167-175
    CrossrefPubMedGoogle Scholar
  • 14 Sadot E, Groot Koerkamp B, Leal JN. , et al. Resection margin and survival in 2368 patients undergoing hepatic resection for metastatic colorectal cancer: surgical technique or biologic surrogate?. Ann Surg 2015; 262 (03) 476-485 , discussion 483–485
    CrossrefPubMedGoogle Scholar
  • 15 Dhir M, Lyden ER, Wang A, Smith LM, Ullrich F, Are C. Influence of margins on overall survival after hepatic resection for colorectal metastasis: a meta-analysis. Ann Surg 2011; 254 (02) 234-242
    CrossrefPubMedGoogle Scholar
  • 16 Liu W, Sun Y, Zhang L, Xing BC. Negative surgical margin improved long-term survival of colorectal cancer liver metastases after hepatic resection: a systematic review and meta-analysis. Int J Colorectal Dis 2015; 30 (10) 1365-1373
    CrossrefPubMedGoogle Scholar
  • 17 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 (05) 715-722 , discussion 722–724
    CrossrefPubMedGoogle Scholar
  • 18 Fretland AA, Dagenborg VJ, Bjørnelv GMW. , et al. Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg 2018; 267 (02) 199-207
    CrossrefPubMedGoogle Scholar
  • 19 Ciria R, Ocaña S, Gomez-Luque I. , et al. A systematic review and meta-analysis comparing the short- and long-term outcomes for laparoscopic and open liver resections for liver metastases from colorectal cancer. Surg Endosc 2020; 34 (01) 349-360
    CrossrefPubMedGoogle Scholar
  • 20 Aghayan DL, Fretland AA, Kazaryan AM. , et al. Laparoscopic versus open liver resection in the posterosuperior segments: a sub-group analysis from the OSLO-COMET randomized controlled trial. HPB (Oxford) 2019; 21 (11) 1485-1490
    CrossrefPubMedGoogle Scholar
  • 21 Wakabayashi G, Cherqui D, Geller DA. , et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 2015; 261 (04) 619-629
    PubMedGoogle Scholar
  • 22 van Kessel CS, Buckens CF, van den Bosch MA, van Leeuwen MS, van Hillegersberg R, Verkooijen HM. Preoperative imaging of colorectal liver metastases after neoadjuvant chemotherapy: a meta-analysis. Ann Surg Oncol 2012; 19 (09) 2805-2813
    CrossrefPubMedGoogle Scholar
  • 23 Asenbaum U, Kaczirek K, Ba-Ssalamah A. , et al. Post-hepatectomy liver failure after major hepatic surgery: not only size matters. Eur Radiol 2018; 28 (11) 4748-4756
    CrossrefPubMedGoogle Scholar
  • 24 Adams RB, Aloia TA, Loyer E, Pawlik TM, Taouli B, Vauthey JN. ; Americas Hepato-Pancreato-Biliary Association; Society of Surgical Oncology; Society for Surgery of the Alimentary Tract. Selection for hepatic resection of colorectal liver metastases: expert consensus statement. HPB (Oxford) 2013; 15 (02) 91-103
    CrossrefPubMedGoogle Scholar
  • 25 van Lienden KP, van den Esschert JW, de Graaf W. , et al. Portal vein embolization before liver resection: a systematic review. Cardiovasc Intervent Radiol 2013; 36 (01) 25-34
    CrossrefPubMedGoogle Scholar
  • 26 Ribero D, Abdalla EK, Madoff DC, Donadon M, Loyer EM, Vauthey JN. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg 2007; 94 (11) 1386-1394
    CrossrefPubMedGoogle Scholar
  • 27 Baumgart J, Jungmann F, Bartsch F. , et al. Two-stage hepatectomy and alpps for advanced bilateral liver metastases: a tailored approach balancing risk and outcome. J Gastrointest Surg 2019; 23 (12) 2391-2400
    CrossrefPubMedGoogle Scholar
  • 28 Lau WY, Lai EC, Lau SH. Associating liver partition and portal vein ligation for staged hepatectomy: the current role and development. Hepatobiliary Pancreat Dis Int 2017; 16 (01) 17-26
    CrossrefPubMedGoogle Scholar
  • 29 Van Cutsem E, Köhne CH, Láng I. , et al. Cetuximab plus irinotecan, fluorouracil, and leucovorin as first-line treatment for metastatic colorectal cancer: updated analysis of overall survival according to tumor KRAS and BRAF mutation status. J Clin Oncol 2011; 29 (15) 2011-2019
    CrossrefPubMedGoogle Scholar
  • 30 Abdalla EK, Vauthey JN. Colorectal metastases: resect or ablate?. Ann Surg Oncol 2006; 13 (05) 602-603
    CrossrefPubMedGoogle Scholar
  • 31 van Duijnhoven FH, Jansen MC, Junggeburt JM. , et al. Factors influencing the local failure rate of radiofrequency ablation of colorectal liver metastases. Ann Surg Oncol 2006; 13 (05) 651-658
    CrossrefPubMedGoogle Scholar
  • 32 Gillams AR, Lees WR. Radio-frequency ablation of colorectal liver metastases in 167 patients. Eur Radiol 2004; 14 (12) 2261-2267
    CrossrefPubMedGoogle Scholar
  • 33 Bipat S, van Leeuwen MS, Ijzermans JN. , et al. Evidence-base guideline on management of colorectal liver metastases in the Netherlands. Neth J Med 2007; 65 (01) 5-14
    PubMedGoogle Scholar
  • 34 Gillams AR, Lees WR. Five-year survival in 309 patients with colorectal liver metastases treated with radiofrequency ablation. Eur Radiol 2009; 19 (05) 1206-1213
    CrossrefPubMedGoogle Scholar
  • 35 Wong SL, Mangu PB, Choti MA. , et al. American Society of Clinical Oncology 2009 clinical evidence review on radiofrequency ablation of hepatic metastases from colorectal cancer. J Clin Oncol 2010; 28 (03) 493-508
    CrossrefPubMedGoogle Scholar
  • 36 Tanis E, Nordlinger B, Mauer M. , et al. Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer 2014; 50 (05) 912-919
    CrossrefPubMedGoogle Scholar
  • 37 Adam R, De Gramont A, Figueras J. , et al; Jean-Nicolas Vauthey of the EGOSLIM (Expert Group on OncoSurgery management of LIver Metastases) group. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist 2012; 17 (10) 1225-1239
    CrossrefPubMedGoogle Scholar
  • 38 Van Cutsem E, Cervantes A, Adam R. , et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016; 27 (08) 1386-1422
    CrossrefPubMedGoogle Scholar
  • 39 Venook A, Niedzwiecki D, Lenz H. , et al. CALGB/SWOG 80405: analysis of patients undergoing surgery as part of treatment strategy. Ann Oncol 2014; 25: 1-41
    PubMedGoogle Scholar
  • 40 Wong R, Cunningham D, Barbachano Y. , 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 (09) 2042-2048
    CrossrefPubMedGoogle Scholar
  • 41 Folprecht G, Gruenberger T, Bechstein W. , et al. Survival of patients with initially unresectable colorectal liver metastases treated with FOLFOX/cetuximab or FOLFIRI/cetuximab in a multidisciplinary concept (CELIM study). Ann Oncol 2014; 25 (05) 1018-1025
    CrossrefPubMedGoogle Scholar
  • 42 Uetake H, Yasuno M, Ishiguro M. , et al. A multicenter phase II trial of mFOLFOX6 plus bevacizumab to treat liver-only metastases of colorectal cancer that are unsuitable for upfront resection (TRICC0808). Ann Surg Oncol 2015; 22 (03) 908-915
    CrossrefPubMedGoogle Scholar
  • 43 Salvatore L, Aprile G, Arnoldi E. , et al. Management of metastatic colorectal cancer patients: guidelines of the Italian Medical Oncology Association (AIOM). ESMO Open 2017; 2 (01) e000147
    CrossrefPubMedGoogle Scholar
  • 44 Tosi F, Magni E, Amatu A. , et al. Effect of KRAS and BRAF mutations on survival of metastatic colorectal cancer after liver resection: a systematic review and meta-analysis. Clin Colorectal Cancer 2017; 16 (03) e153-e163
    CrossrefPubMedGoogle Scholar
  • 45 Karagkounis G, Torbenson MS, Daniel HD. , et al. Incidence and prognostic impact of KRAS and BRAF mutation in patients undergoing liver surgery for colorectal metastases. Cancer 2013; 119 (23) 4137-4144
    CrossrefPubMedGoogle Scholar
  • 46 Gryfe R, Kim H, Hsieh ET. , et al. Tumor microsatellite instability and clinical outcome in young patients with colorectal cancer. N Engl J Med 2000; 342 (02) 69-77
    CrossrefPubMedGoogle Scholar
  • 47 Haddad R, Ogilvie RT, Croitoru M. , et al. Microsatellite instability as a prognostic factor in resected colorectal cancer liver metastases. Ann Surg Oncol 2004; 11 (11) 977-982
    CrossrefPubMedGoogle Scholar
  • 48 Fujiyoshi K, Yamamoto G, Takenoya T. , et al. Metastatic pattern of stage IV colorectal cancer with high-frequency microsatellite instability as a prognostic factor. Anticancer Res 2017; 37 (01) 239-247
    PubMedGoogle Scholar
  • 49 Bokemeyer C, Van Cutsem E, Rougier P. , et al. Addition of cetuximab to chemotherapy as first-line treatment for KRAS wild-type metastatic colorectal cancer: pooled analysis of the CRYSTAL and OPUS randomised clinical trials. Eur J Cancer 2012; 48 (10) 1466-1475
    CrossrefPubMedGoogle Scholar
  • 50 Douillard JY, Oliner KS, Siena S. , et al. Panitumumab-FOLFOX4 treatment and RAS mutations in colorectal cancer. N Engl J Med 2013; 369 (11) 1023-1034
    CrossrefPubMedGoogle Scholar
  • 51 Seymour MT, Brown SR, Middleton G. , et al. Panitumumab and irinotecan versus irinotecan alone for patients with KRAS wild-type, fluorouracil-resistant advanced colorectal cancer (PICCOLO): a prospectively stratified randomised trial. Lancet Oncol 2013; 14 (08) 749-759
    CrossrefPubMedGoogle Scholar
  • 52 Carethers JM, Smith EJ, Behling CA. , et al. Use of 5-fluorouracil and survival in patients with microsatellite-unstable colorectal cancer. Gastroenterology 2004; 126 (02) 394-401
    CrossrefPubMedGoogle Scholar
  • 53 Des Guetz G, Uzzan B, Nicolas P, Schischmanoff O, Perret GY, Morere JF. Microsatellite instability does not predict the efficacy of chemotherapy in metastatic colorectal cancer. A systematic review and meta-analysis. Anticancer Res 2009; 29 (05) 1615-1620
    PubMedGoogle Scholar
  • 54 Bever KM, Le DT. An expanding role for immunotherapy in colorectal cancer. J Natl Compr Canc Netw 2017; 15 (03) 401-410
    CrossrefPubMedGoogle Scholar
  • 55 Basile D, Garattini SK, Bonotto M. , et al. Immunotherapy for colorectal cancer: where are we heading?. Expert Opin Biol Ther 2017; 17 (06) 709-721
    CrossrefPubMedGoogle Scholar
  • 56 Hoti E, Adam R. Liver transplantation for primary and metastatic liver cancers. Transpl Int 2008; 21 (12) 1107-1117
    CrossrefPubMedGoogle Scholar
  • 57 Hagness M, Foss A, Line PD. , et al. Liver transplantation for nonresectable liver metastases from colorectal cancer. Ann Surg 2013; 257 (05) 800-806
    CrossrefPubMedGoogle Scholar
  • 58 Dueland S, Syversveen T, Solheim JM. , et al. Survival following liver transplantation for patients with nonresectable liver-only colorectal metastases. Ann Surg 2020; 271 (02) 212-218
    CrossrefPubMedGoogle Scholar
  • 59 Foss A, Adam R, Dueland S. Liver transplantation for colorectal liver metastases: revisiting the concept. Transpl Int 2010; 23 (07) 679-685
    CrossrefPubMedGoogle Scholar
  • 60 Dueland S, Foss A, Solheim JM, Hagness M, Line PD. Survival following liver transplantation for liver-only colorectal metastases compared with hepatocellular carcinoma. Br J Surg 2018; 105 (06) 736-742
    CrossrefPubMedGoogle Scholar
  • 61 Chotai P, Matsuoka L. Reassessing the role of liver transplantation for patients with metastatic colorectal cancer to the liver. Curr Opin Organ Transplant 2019; 24 (02) 118-120
    CrossrefPubMedGoogle Scholar