- 50% patients with colorectal cancer develop liver metastases
- 20% have metastases at time of initial surgery
- 25% develop metastases within 5 years of a 'curative' resection
- Median survival with metastases is about one year
Detection of metastases
- Value of intensive follow-up after curative resection for colorectal cancer is controversial
- Ultrasound will detect lesion more than 0.5 cm in diameter
- CT allows assessment of resectability
- Intra-operative ultrasound superior to extra-corporeal scanning
- Elevated tumour marker - CEA, CA 19.9, CA 242
Liver resection for metastatic disease
- Resectional surgery is only chance of cure for patients with liver metastases
- Only 10% of patients with metastases suitable for 'curative' hepatic resection
- Aim is to resect tumour with more than 1 cm margin by segmentectomy, lobectomy or hepatectomy
- 5 year survival 35% and 10 year survival 20%
Relative indications for surgical resection
- Single lobe involvement
- Less than three lesions without evidence of satellite lesions
- No invasion of inferior vena cava
- More than 20% of liver can be spared
Relative contra-indications for surgical resection
- Hilar and coeliac nodal involvement
- Distant metastases
- Poor cardiovascular reserve
- Pre-operative portal vein embolisation - atrophy of segments to be excised
- Neoadjuvant chemotherapy
Palliation of liver metastases
- Cryotherapy
- Hepatic artery infusion therapy
- Laser photo-coagulation
Bibliography
Heriot A G, Karanjia N D. A review of techniques for liver resection. Ann R Coll Surg
Eng 2002; 84: 371-380.
Renehan A G, Egger M, Saunders M P, O'Dwyer S T. Impact on survival of intensive
follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised
trials. Br J Med 2002; 324: 1-8. |