Clinical Outcomes for Liver Metastases

Abstract

Liver resection is associated with prolonged survival in patients with colorectal liver metastases. Unfortunately, only 15–25% of patients with colorectal liver metastases are candidates for surgery at the time of diagnosis of the metastatic disease. To date, the definition of resectability of colorectal liver metastases is based on complete resection and preservation of sufficient future liver remnant (FLR). In patients with unresectable colorectal liver metastases, portal vein embolization (PVE) induces hypertrophy of the FLR and allows safe liver resection. The safety and the usefulness of this procedure have been evaluated in large series of patients with colorectal liver metastases. Depending on the quality of the liver parenchyma, portal vein embolization is recommended for patients whose standardized FLR is less than 20% in normal liver, less than 30% in case of hepatic injury, and less than 40% in case of fibrosis or cirrhosis. The role of PVE has not been specifically evaluated in patients with metastases from other malignancies (neuroendocrine tumor or noncolorectal nonneuroendocrine liver metastases). However, the indications for PVE are dictated by the volume of the FLR and the quality of liver parenchyma, and the guidelines provided for colorectal liver metastases also apply to other types of liver metastases.