Surgery as a treatment for liver metastases |
The liver is the second most common site of spread after the lymph nodes from cancers arising in other sites in the body. For colorectal cancer, it is the most common and frequently the only site of metastatic disease (30-40% of patients). Approximately 25% of patients will present with metastases at the time of initial diagnosis. Treatment options for patients with metastatic colorectal cancer are limited. Only around a third of patients with colorectal metastatic disease are eligible for curative surgical removal. Strategies have now been developed to remove what in the near past was considered as 'unresectable' disease. Treatment often develops through multiple stages and requires close cooperation with various specialists. Thus, the optimal management of patients with colorectal liver metastases can only be provided by a specialist team comprising a liver surgeon, oncologist, interventional radiologist and histopathologist, who have an in-depth understanding of the latest diagnostic and therapeutic options formulated through multidisciplinary forums. Surgery is the only treatment option for colorectal metastatic disease that is associated with a long term survival or in some cases is regarded to be curative. Five-year survival rates following resection range between 25% and 39%, with a median survival between 28 and 40 months. Whereas in patients with non-resected colorectal liver metastases the median survival is only 5-10 months and five-year survival is extremely rare.
Approximately 20-30% of patients with metastatic colorectal cancer have disease that is confined to the liver and thus is potentially resectable. The aim of liver resection is to remove all macroscopic disease together with clear margins and leave sufficient liver tissue to allow normal hepatic function.
Operating on the liver can be difficult for several reasons. Many of the major blood vessels to and from the heart pass behind or through the liver, so in essence, the liver is "attached" to the heart. Also, the anatomy of the liver is not always obvious from the surface. The organ is large, dense, and delicate, and covered in part by the rib cage. It bleeds profusely when injured and its tissue tears easily. An experienced surgeon can offer a patient the best chance for a good outcome.
New technologies allow surgeons to remove increasingly smaller portions of the liver. This results in less loss of blood and a quicker recovery. One of the new technologies uses laparoscopic surgical methods. In this type of surgery, a small incision is made and a tube with a small camera attached to its end is passed through the abdominal wall. This technique can be used in selected cases to remove part of the liver (partial hepatectomy). Since the procedure is less invasive than traditional surgery, recovery is quicker.
When the liver is burdened with another disease aside from the cancer, surgery is complicated and sometimes impossible. A disease such as cirrhosis dramatically weakens the liver and often leaves it permanently damaged, with limited regenerative capacity. If patients are not good candidates for surgery, they should be considered for ablative therapy (cryosurgery, radioactive ablation, embolization, alcohol ablation).
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