>Year 2010, Issue 3
Multidisciplinary management of hepatic metastases from colorectal cancer
Cir Gen 2010; 32 (3)
PDF: 4. Kb.
Objective: To review the main controversies in the multidisciplinary management of hepatic metastatic disease from colorectal cancer.
Setting: Third level health care center. Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”.
Design: Review of the literature.
Material and methods: A review of the literature was made with respect to the new treatments that have given rise to controversies in terms of the adequateness of combining pharmacological agents, the optimal sequence of their use in relation to the performed surgery, and the impact of these treatments on the surgical outcome. The assessed therapies were neoadjuvant chemotherapy, ablation versus resection of the metastatic lesion, and hepatic resection in the presence of extrahepatic disease.
Results: Neoadjuvant chemotherapy can: 1) serve as an in vivo chemosensitivity test that will guide in choosing the therapeutic scheme after surgery; 2) eliminate micrometastatic disease already present but not visible in the hepatic parenchyma, 3) help in reducing the tumoral volume, which will allow performing a more conservative resection and increase the rate of complete surgical resection of the metastasis. The response to chemotherapy can become an important prognostic marker. Its administration has been associated with pathological changes in the hepatic parenchyma; however, this does not impact morbidity, mortality, or survival. Regarding ablation versus resection of lesions, the results are not comparable because of the lack of prospective studies. This leaves resection as the golden standard. Regarding hepatic resection in the presence of extrahepatic disease, it is known that resection of hepatic metastases in the presence of ganglionic metastases in the portal hilum should only be done in carefully chosen patients, as it implies a poor prognostic factor. Resection of synchronous pulmonary and hepatic metastases in well chosen patients is associated with a long term survival potential. Finally, the change in the concept that peritoneal metastases not always represent systemic dissemination of the disease, and could be a form of regional recurrence accessible to localized treatment is discussed.
Conclusion: The changes in the concepts regarding hepatic resection in colorectal cancer must be assessed in controlled clinical trials to reach a clear definition.
||Colorectal cancer, metastases, liver.
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>Year 2010, Issue 3