Treatment of liver metastases in colorectal cancer

From WikiLectures

The Czech Republic ranks first in the world in the incidence of colorectal cancer. Despite screening programs, there are still a large number of patients who have distant, especially hepatic, metastases.

In most other malignancies (breast tumors, bronchogenic carcinoma), liver metastases are a sign of a highly advanced finding that is no longer resolved by any radical (curative) resection, but this does not apply to colorectal carcinoma. In fact , curative resections of cancer can be performed in 10-20% of colorectal cancer patients who have liver metastases[1]. Therefore, their treatment should receive increased attention. The result is 40% five-year patient survival[1][2].

_fetch_thumbnail.php?img=Mnohocetne%20metastazy%20jater-CT-0_0001.jpg CT: metastatické postižení jater

Types of metastases[edit | edit source]

According to the time of occurrence, we distinguish metastases:

  • synchronous - diagnosed with primary tumor;
  • metachronous - diagnosed only after resection of the primary tumor.

In the case of synchronous metastases, resection at the same time together with tumor and lymphadenectomy is recommended.

Therapy procedure[edit | edit source]

The following are important for the treatment procedure:

  • the overall biological status of the patient and staging cancer;
  • liver function.
Procedure for the treatment of liver metastases in patients with colorectal cancer.
File:Liver meta scheme.PNG
Procedure for the treatment of liver metastases in patients with colorectal cancer.

Resectable liver metastases[edit | edit source]

A patient with resectable metastases can be operated on immediately and then undergo adjuvant chemotherapy, or first undergo neoadjuvant chemotherapy, then resection and adjuvant treatment.

Potentially resectable metastases[edit | edit source]

Patients with potentially resectable metastases first undergo indicative biochemotherapy, after 3 months of restaging, when a final decision is made as to whether they are resectable or not.

Unresectable liver metastases[edit | edit source]

The only possible procedure is palliative chemoradiotherapy.

Chemotherapy[edit | edit source]

The response of liver metastases to chemotherapy is quite high, in 50–60% of cases they regress or even disappear (4-7%) on CT examination. The disadvantage is the formation of vascular lesions after some preparations:

  • blue liver - sinusoidal obstruction syndrome (SOS) after oxaliplatin;
  • yellow liver - liver steatosis (CASH) after irinotecan.

Bevacizumab may impair the liver's ability to regenerate.

Surgical resection[edit | edit source]

Prior to liver resection, CT volume therapy must be performed to estimate the amount of liver tissue remaining. In general, at least 20% of the functional tissue must be maintained in otherwise healthy livers and up to 40% in affected livers (blue or yellow livers).

Resections of liver metastases can be anatomical (segmentectomy) or non-anatomical (metastatectomy). Currently, non-anatomical resections are preferred because they are performance-saving liver tissue. It is advantageous to save liver tissue in case of further metachronous metastases and other possible resections.

Anatomical resections[edit | edit source]

Anatomical resections include segmentectomy (the liver has 8 segments) and lobectomy. At present, they are not preferred because they are more radical performances.

Non - anatomical resections[edit | edit source]

NAR (non-anatomical resection) is a performance-saving parenchyma. Perioperative sonography is necessary to clarify the location of metastases during surgery. Previously, a 1-2 cm border of healthy parenchyma around the resected metastasis was required. This is already being abandoned, less is enough.

Links[edit | edit source]

Related Articles[edit | edit source]

Source[edit | edit source]

Reference[edit | edit source]

  1. a b

Source[edit | edit source]