| Selection for hepatic resection of colorectal liver metastases: expert consensus statement. | |
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MedLine Citation:
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PMID: 23297719 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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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. |
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Authors:
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Reid B Adams; Thomas A Aloia; Evelyne Loyer; Timothy M Pawlik; Bachir Taouli; Jean-Nicolas Vauthey |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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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:
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Created Date: 2013-01-09 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100900921 Medline TA: HPB (Oxford) Country: England |
Other Details:
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Languages: eng Pagination: 91-103 Citation Subset: IM |
Copyright Information:
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© 2012 International Hepato-Pancreato-Biliary Association. |
Affiliation:
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Division of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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