Management of Colorectal Liver Metastasis

Abstract

Colorectal cancer is the most common gastrointestinal malignancy all over the world. As with many types of cancer, death from colorectal cancer is often a result of metastatic disease. Over one-half of patients who die of colorectal cancer have liver metastases at autopsy, and the majority of these patients die as a result of their metastatic liver disease. But unlike many other types of cancer, the presence of distant metastases from colorectal cancer does not preclude curative treatment. Resection of hepatic metastases from colorectal cancer offers the best chance of long-term survival. Unfortunately the majority of patients with colorectal hepatic metastases are not suitable for resection and therefore specific criteria should be used to select those who may benefit from such intervention. In patients with colorectal cancer, synchronous liver metastases may be detected during preoperative testing or identified intra-operatively during colectomy. Metachronous liver metastases may be suspected at some point after colectomy. In patients who are candidates for surgical resection of their liver metastases, the goals of preoperative assessment are: A) to exclude the presence of extrahepatic disease; B) to delineate the anatomy of the metastases, and C) to determine the ability of the patient to tolerate hepatic resection. Preoperative evaluation requires a complete medical evaluation to determine the patient’s suitability for surgery as well as detailed anatomic imaging to determine the location of the liver tumors and to exclude extra hepatic metastasis. Radiological evaluation is needed not only to identify extra hepatic disease but also to assess the adequacy of liver parenchyma after surgery. In addition to the patient evaluation, liver function tests are evaluated to assess the synthetic function of the liver; combined with radiological findings, these tests can aid in the decision-making process. Many different non-invasive imaging modalities are available for the visualization of liver metastasis. The options include computed tomography, magnetic resonance imaging, ultrasound and positron emission tomography using fluorine-18 labelledfluorodeoxy-glucose.