Intrabiliary metastases in colorectal cancer. A systematic review

Abstract

Background: Liver metastases emerge in 25-50% patients during colorectal cancer (CRC) and iIntrabiliary growth is present in a small proportion of these patients. Intrabiliary metastases (IBM) include microscopic/macroscopic bile duct invasion with hepatic lesions, intrabiliary lesion without hepatic mass and extrahepatic bile duct lesions. Literature is scarce about IBM, its radiological diagnosis, the most suitable treatment and its prognosis. Material & Methods: A systematic search according PRISMA guidelines without limits was performed. The selected studies included patients with a diagnosis of CRC and associated IBM, either synchronous or metachronous mestastases. Results: Forty studies were selected: 30 case report and 10 case series. The epidemiological data were mostly men in the sixth decade of life. The median time between diagnosis of the primary tumor and hepatic metastases was 46.7 months (range: 0-180). Most CRC metastases are CK7- / CK20 + (Figure 1 shows histological images). Treatment ranged from endoscopic resection to mayor hepatic resections combined with pancreatectomies. When curative surgery was no possible, palliative treatments included biliary prosthesis or no treatment. The survival data are confusing. About prognosis, patients with macroscopic IBM show better survival (5 years: 80%) than microscopic IBM (48%) or without bile duct infiltration (57%). Conclusion: IBM should be considered in all patients with a history of CRC presenting dilatation of the bile duct. It is necessary to standardize the definition of this pathology, since the existing terminology may cause confusion and make it difficult to carry out case studies and case series. Surgery is the only curative treatment, but more studies are needed to determine the most appropriate type of liver resection. Anatomic surgery is defended to obtain free margins of the bile duct, while a more economic surgery increases risk of recurrence.