Surgical treatment of colorectal cancer metastases

Velimir Škrbić,Dalibor Šaran,Milan Simatović,Goran Janjić

doi:10.5937/scriptamed51-26579

Abstract

Background/Aim: Colorectal metastatic liver tumours are the most common secondary liver tumours. During the life of patients with colorectal tumorous, this liver metastases will develop either synchronously or metachronously in half of the patients. Approximately 25 % of patients with colorectal cancer diagnosis have secondary deposits in the liver and the additional 25 % of patients will develop metastases within five years. The objective was to investigate whether anatomic resections of the liver present a method of choice in surgical treatment of colorectal liver metastases compared to metastasectomy surgery. Methods: A total of 65 patients were divided into two groups. Patients in the first group underwent metastasectomies consisting in the removal of metastases and the surrounding liver parenchyma no more than 1 cm by Kelly clamp crushing technique or LigaSure vessel-sealing system. Patients in the second group were subjected to the anatomic resection of the liver where not only metastases were removed, but also the associated anatomical segment or section or half the liver, depending on the number and localisation of metastases. Results: The mean values (± standard deviation) of the overall survival for the first and the second group were 36 ± 4.8 months and 36 ± 2.6 months, respectively. The mean values (± standard deviation) of the disease-free survival in the first and in the second group were 18 ± 2.22 months and 22 ± 0.74 months, respectively. None of the found inter-group differences were statistically significant. Conclusion: It can be concluded that metastatic surgery for colorectal liver metastases and anatomic resections have almost the same results and are irreplaceable methods in the treatment of colorectal liver metastases.

Highlights

Colorectal cancer is the most common gastrointestinal malignant tumour that gives rise to metastatic liver tumours.[1]
The objective was to investigate whether anatomic resections of the liver present a method of choice in surgical treatment of colorectal liver metastases compared to metastasectomy surgery
It can be concluded that metastatic surgery for colorectal liver metastases and anatomic resections have almost the same results and are irreplaceable methods in the treatment of colorectal liver metastases

Summary

Introduction

Colorectal cancer is the most common gastrointestinal malignant tumour that gives rise to metastatic liver tumours.[1] Approximately 25 % of patients with colorectal cancer at time of diagnosis have presence of secondary liver metastases and in 25 % of patients metastases are generated within the five years.[2] The first liver resection for colorectal liver metastases was performed by Catell in 1940. By improvement of surgical techniques, by introducing of new cytostatic drugs and by reducing the resection margin to less than 1 cm, the application of interventional radiology, portal venous embolisation allowed more patients in the unresectable group to move to the resectable tumour group. The goal of treatment is surgical removal of all metastatic tumours in the liver, because, based on the experience, 25-60 % of the operated patients survive for five years.[2] Seventy percent of the conservatively treated patients with metastases in the liver do not survive even a year.[3]

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Methods

Conclusion