Comprehensive Management of Disseminated Colorectal Cancer

Abstract

In 1977, Foster and Berman published a book showing surprising long-term benefits from the resection of liver tumors. 1 Adson and colleagues from the Mayo Clinic in 1984 focused on the resection of isolated dissemination of colorectal cancer to the liver. 2 Shortly thereafter, Hughes and colleagues reinforced these data by publishing a multiinstitutional registry of colorectal cancer metastases. This survey of 859 patients established a survival rate of approximately 30% in this large group of patients previously expected to have a 0% 5-year survival. 3 Hughes and colleagues also established the pattern of failure to be expected after liver resection. 4 Fernandez-Trigo and colleagues constructed a similar registry of repeat liver resections for colorectal cancer. 5 They established that reoperation in this clinical setting was equally beneficial to the first resection. Numerous publications have established the prognostic indicators to be used to select these patients. 6,7 However, no single clinical feature, such as multiple liver metastases, could be used as an absolute contraindication to liver resection. Even patients with concomitant liver metastases and other sites of disseminated disease could benefit from cancer resection. 8,9 The single clinical requirement necessary for a potentially curative surgical intervention was complete resection of all sites of disease. As the requirement for complete resection of colorectal liver metastases was recognized as an absolute requirement of long-term benefit, Adam and colleagues developed treatment strategies to convert unresectable to resectable disease. 10 Neoadjuvant chemotherapy with 5-fluorouracil