Document Detail


Selection for hepatic resection of colorectal liver metastases: expert consensus statement.
MedLine Citation:
PMID:  23297719     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hepatic resection offers a chance of a cure in selected patients with colorectal liver metastases (CLM). To achieve adequate patient selection and curative surgery, (i) precise assessment of the extent of disease, (ii) sensitive criteria for chemotherapy effect, (iii) adequate decision making in surgical indication and (iv) an optimal surgical approach for pre-treated tumours are required. For assessment of the extent of the disease, contrast-enhanced computed tomography (CT) and/or magnetic resonance imaging (MRI) with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is recommended depending on the local expertise and availability. Positron emission tomography (PET) and PET/CT may offer additive information in detecting extrahepatic disease. The RECIST criteria are a reasonable method to evaluate the effect of chemotherapy. However, they are imperfect in predicting a pathological response in the era of modern systemic therapy with biological agents. The assessment of radiographical morphological changes is a better surrogate of the pathological response and survival especially in the patients treated with bevacizumab. Resectability of CLM is dependent on both anatomic and oncological factors. To decrease the surgical risk, a sufficient volume of liver remnant with adequate blood perfusion and biliary drainage is required according to the degree of histopathological injury of the underlying liver. Portal vein embolization is sometimes required to decrease the surgical risk in a patient with small future liver remnant volume. As a complete radiological response does not signify a complete pathological response, liver resection should include all the site of a tumour detected prior to systemic treatment.
Authors:
Reid B Adams; Thomas A Aloia; Evelyne Loyer; Timothy M Pawlik; Bachir Taouli; Jean-Nicolas Vauthey; ; ;
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Publication Detail:
Type:  Journal Article; Practice Guideline    
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:  91-103     Citation Subset:  IM    
Copyright Information:
© 2012 International Hepato-Pancreato-Biliary Association.
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MeSH Terms
Descriptor/Qualifier:
Angiogenesis Inhibitors / therapeutic use
Antibodies, Monoclonal, Humanized / therapeutic use
Colorectal Neoplasms / diagnosis*,  drug therapy,  pathology,  surgery*
Consensus Development Conferences as Topic
Contrast Media / diagnostic use
Gadolinium / diagnostic use
Hepatectomy* / methods
Humans
Liver Neoplasms / diagnosis*,  drug therapy,  secondary,  surgery*
Magnetic Resonance Imaging
Multimodal Imaging
Neoplasm Staging
Patient Selection*
Positron-Emission Tomography
Risk Assessment
Tomography, X-Ray Computed
Treatment Outcome
Chemical
Reg. No./Substance:
0/Angiogenesis Inhibitors; 0/Antibodies, Monoclonal, Humanized; 0/Contrast Media; 2S9ZZM9Q9V/bevacizumab; AU0V1LM3JT/Gadolinium
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