Home > Riviste > Minerva Medica > Fascicoli precedenti > Minerva Medica 2017 December;108(6) > Minerva Medica 2017 December;108(6):527-46

ULTIMO FASCICOLO
 

ARTICLE TOOLS

Publication history
Estratti
Per citare questo articolo

MINERVA MEDICA

Rivista di Medicina Interna


Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,878


eTOC

 

REVIEW  


Minerva Medica 2017 December;108(6):527-46

DOI: 10.23736/S0026-4806.17.05371-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Multidisciplinary treatment of colorectal liver metastases

Tobias S. SCHIERGENS 1, Jobst von EINEM 2, Michael N. THOMAS 1, Markus ALBERTSMEIER 1, Clemens GIESSEN-JUNG 2, Maximilian DÖRSCH 1, Christian HEILIGER 1, Moritz DREFS 1, Joachim ANDRASSY 1, Dominik P. MODEST 2, Sebastian STINTZING 2, Markus GUBA 1, Martin ANGELE 1, Jens WERNER 1, Markus RENTSCH 1

1 Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, University of Munich, Munich, Germany; 2 Department of Medical Oncology, University of Munich, Munich, Germany


PDF  


INTRODUCTION: The therapy of patients with colorectal liver metastases (CRLM) has undergone significant changes. Extended survival has been observed to be associated with adoption of hepatic resection and improved chemotherapy.
EVIDENCE ACQUISITION: This review summarizes standards, developments and controversies on the management of these patients. Literature search was performed with focus on work published within the last ten years.
EVIDENCE SYNTHESIS: Patients with CRLM should undergo surgery whenever possible with careful and experienced patient selection as hepatic resection offers the best long-term prognosis. The multidisciplinary approach has markedly evolved and has increased the number of patients in whom curative-intended surgery is possible. Patients with resectable metastases can undergo upfront surgery or may receive perioperative chemotherapy in selected cases, a decision which is under debate and remains individual. Patients with non-resectable metastases that may become resectable upon conversion treatment should receive polychemotherapy with or without local ablative therapy as pretreatment with the main goal of achieving resectability. In patients with synchronous CRLM, the optimal sequence of treatment remains unclear. Depending on the hepatic tumor burden and its dynamics as well as the type and stage of the primary tumor, simultaneous resection or either the sequential “bowel-first” or reversed “liver-first” approach represent suitable options to achieve complete tumor clearance.
CONCLUSIONS: The improvements in the management of CRLM due to multidisciplinary treatment and novel developments are a great example of successfully pushing the boundaries of cure in metastatic cancer. Surgery aiming at complete tumor clearance represents the central instrument to achieve long-term survival.


KEY WORDS: Colorectal neoplasms - Neoplasm metastasis - Hepatectomy - Metastasectomy - Drug therapy

inizio pagina

Publication History

Issue published online: November 2, 2017
Article first published online: September 8, 2017
Manuscript accepted: July 28, 2017
Manuscript received: July 28, 2017

Per citare questo articolo

Schiergens TS, von Einem J, Thomas MN, Albertsmeier M, Giessen-Jung C, Dörsch M, et al. Multidisciplinary treatment of colorectal liver metastases. Minerva Med 2017;108:527-46. DOI: 10.23736/S0026-4806.17.05371-X

Corresponding author e-mail

markus.rentsch@med.lmu.de