Current management of colorectal hepatic metastasis

Department of Surgery, Division of Surgical Oncology, The Johns Hopkins 600 North Wolfe Street, Halsted 614, Baltimore, MD 21287, USA.
Expert review of gastroenterology & hepatology (Impact Factor: 2.42). 05/2009; 3(2):131-44. DOI: 10.1586/egh.09.8
Source: PubMed


In the USA, cancers of the colon and rectum are the third most common site of new cancer cases and cancer deaths. With improved screening and adjuvant therapy, the survival of patients has increased substantially over the last decade. However, patients with metastatic disease often have limited survival. Hepatic metastasis is one of the most frequent sites of metastatic disease. In fact, 35-55% of patients with colorectal cancer will develop hepatic metastasis at some time during the course of their disease. Patients who are able to undergo complete resection of their hepatic metastases have the best chance of long-term survival. The goal of hepatic resection is to achieve complete resection of all metastases with microscopically negative surgical margins while preserving sufficient hepatic parenchyma. Survival following hepatic resection of colorectal metastasis now approaches 35-50%. However, approximately 65% of patients will have a recurrence at 5 years. Increasingly chemotherapeutic agents are being offered in the preoperative setting prior to operation. At the time of operation, patients with extensive hepatic disease can sometimes be offered ablative therapies combined with resection or staged approaches. Modern management of hepatic colorectal metastases necessitates a multidisciplinary approach to effectively treat these patients and increase the number of patients who will benefit from resection.

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    • "Colorectal cancer (CRC) is one of the most common cancers and is the second leading cause of cancer-related deaths worldwide (Ferlay et al., 2011; Markowitz & Bertagnolli, 2009). Metastasis is considered to be the critical cause of CRC patient mortality (Carpizo & D'Angelica, 2009; Mayo & Pawlik, 2009). In metastasis, cancer cells spread to distant organs through blood or lymphatic vessels, circulate through the intravascular stream, and then proliferate at another site (Folkman, 1971). "
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    • "Survival following hepatic resection of colorectal metastasis now approaches 35%-50%. However, the recurrence rate in 5 years is as high as approximately 65% 3. To date, the precise mechanisms leading to liver metastasis in colon cancer remains unknown, and biomarkers for liver metastasis are still lacking. "
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    • "When developing an effective anti-tumor therapeutic agent, it is important to develop agents which inhibit tumor recurrence [19]. The metastatic ability of cancer cells to migrate from their origin to other target tissues is one of the major reasons that make it difficult to develop an efficient anti-cancer agent [20], [21]. In our heterotopic cancer animal model, we observed that subcutaneous inoculation of CT-26 colon cancer cells caused spontaneous metastasis of the cells into the lung tissue (Fig. 6A). "
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