Document Detail


Locoregional surgical and interventional therapies for advanced colorectal cancer liver metastases: expert consensus statements.
MedLine Citation:
PMID:  23297723     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Selection of the optimal surgical and interventional therapies for advanced colorectal cancer liver metastases (CRLM) requires multidisciplinary discussion of treatment strategies early in the trajectory of the individual patient's care. This paper reports on expert consensus on locoregional and interventional therapies for the treatment of advanced CRLM. Resection remains the reference treatment for patients with bilateral CRLM and synchronous presentation of primary and metastatic cancer. Patients with oligonodular bilateral CRLM may be candidates for one-stage multiple segmentectomies; two-stage resection with or without portal vein embolization may allow complete resection in patients with more advanced disease. After downsizing with preoperative systemic and/or regional therapy, curative-intent hepatectomy requires resection of all initial and currently known sites of disease; debulking procedures are not recommended. Many patients with synchronous primary disease and CRLM can safely undergo simultaneous resection of all disease. Staged resections should be considered for patients in whom the volume of the future liver remnant is anticipated to be marginal or inadequate, who have significant medical comorbid condition(s), or in whom extensive resections are required for the primary cancer and/or CRLM. Priority for liver-first or primary-first resection should depend on primary tumour-related symptoms or concern for the progression of marginally resectable CRLM during treatment of the primary disease. Chemotherapy delivered by hepatic arterial infusion represents a valid option in patients with liver-only disease, although it is best delivered in experienced centres. Ablation strategies are not recommended as first-line treatments for resectable CRLM alone or in combination with resection because of high local failure rates and limitations related to tumour size, multiplicity and intrahepatic location.
Authors:
Eddie K Abdalla; Todd W Bauer; Yun S Chun; Michael D'Angelica; David A Kooby; William R Jarnagin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  HPB : the official journal of the International Hepato Pancreato Biliary Association     Volume:  15     ISSN:  1477-2574     ISO Abbreviation:  HPB (Oxford)     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-09     Completed Date:  2013-08-02     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  100900921     Medline TA:  HPB (Oxford)     Country:  England    
Other Details:
Languages:  eng     Pagination:  119-30     Citation Subset:  IM    
Copyright Information:
© 2013 International Hepato-Pancreato-Biliary Association.
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MeSH Terms
Descriptor/Qualifier:
Chemoradiotherapy, Adjuvant / methods
Colorectal Neoplasms / pathology*,  therapy*
Consensus Development Conferences as Topic
Embolization, Therapeutic
Hepatectomy* / methods
Humans
Interdisciplinary Communication
Liver Neoplasms / secondary*,  therapy*
Neoplasm Staging
Practice Guidelines as Topic
Randomized Controlled Trials as Topic
Treatment Outcome
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