Limitations in resectability of colorectal liver metastases 2020 – A systematic approach for clinicians and patients. (June 2021)

• Record Type: Journal Article
• Authors: Schadde, Erik; Grunhagen, Dirk J.; Verhoef, Cornelis; Krzywon, Lucyna; Metrakos, Peter
• Is Part Of: Seminars in cancer biology. Volume 71(2021)
• Page Start: 10
• Page End: 20
• Publication Date: 2021-06
• Subjects: 90DM 90-day mortality after surgery -- ALPPS associating liver partition and portal vein ligation for staged hepatectomy -- aFLR adequate future liver remnant -- BCAA branched-chain amino acids -- CEA carcinoembryonic antigen -- CTH chemotherapy -- CRC colorectal cancer -- CRLM colorectal liver metastasis -- CRS clinical risk score (based on clinical features, Fong et al. 1999) -- EPA eicosapentaenoic acid -- ESMO European Society of Medical Oncology -- ESPEN European society of parenteral and enteral nutrition -- ERAS early recovery after surgery -- FLR future liver remnant -- GIN post-operative insulin and glucose administration -- HPB hepato-panceato-biliary -- IOUS intraoperative ultrasound -- IVS inferior vena cava -- MDT multidisciplinary tumor board -- MRI Magnetic resonance imaging -- MRS molecular risk score (based on RNA expression) -- NCCN National Cancer Center Network -- PSH parenchymal sparing hepatectomy -- PV portal vein -- PVE portal vein embolization -- PVE/HVE simultaneous portal vein and hepatic vein embolization -- R0 histologically negative margin -- Rv histologically positive margin at a vascular structure -- RCT randomized controlled trial -- sFLR standardized future liver remnant -- TSH two-stage hepatectomy; Colorectal liver metastases -- Resectability -- Conversion chemotherapy -- Two-stage hepatectomy -- Parenchymal sparing hepatectomy -- Regenerative liver surgery -- Peri-operative mortality; Cancer -- Periodicals; Neoplasms -- Periodicals; Review Literature; Cancer -- Périodiques; Electronic journals; 616.994
• DOI: 10.1016/j.semcancer.2020.09.008
• Languages: English
• ISSNs: 1044-579X

Abstract

Abstract: Colorectal liver metastases (CRLM) affect over 50 % of all patients with colorectal cancer, which is the second leading cause of cancer in the western world. Resection of CRLM may provide cure and improves survival over chemotherapy alone. However, resectability of CLRM has to be decided in multidisciplinary tumor boards and is based on oncological factors, technical factors and patient factors. The advances of chemotherapy lead to the abolition of contraindications to resection in favor of technical resectability, but somatic mutations and molecular subtyping may improve selection of patients for resection in the future. Technical factors center around anatomy of the lesions, volume of the remnant liver and quality of the liver parenchymal. Multiple strategies have been developed to overcome volume limitations and they are reviewed here. The least investigated topic is how to select the right patients among an elderly and frail patient population for the large variety of technical options specifically for bi-lobar CRLM to keep 90-day mortality as low as possible. The review is an overview over the current state-of-the art and a systematic guide to the topic of resectability of CRLM for both clinicians and patients.