Treatment strategies for the management of advanced colorectal liver metastases detected synchronously with the primary tumour

Mentha, G.; Majno, P.; Terraz, S.; Rubbia-Brandt, L.; Gervaz, P.; Andres, A.; Allal, A.S.; Morel, Ph.; Roth, A.D.

doi:10.1016/j.ejso.2007.09.016

« Previous Next »European Journal of Surgical Oncology
Volume 33, Supplement 2 , Pages S76-S83, December 2007

Treatment strategies for the management of advanced colorectal liver metastases detected synchronously with the primary tumour

G. Mentha
- Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
- Corresponding author: Units of Transplantation and Visceral Surgery, Department of Surgery, University Hospital of Geneva, 1211 Geneva 14, Switzerland. Tel.: +41 22 372 7607; fax: +41 22 372 7600.
P. Majno
- Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
S. Terraz
- Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
L. Rubbia-Brandt
- Department of Pathology, University Hospital of Geneva, Geneva, Switzerland
P. Gervaz
- Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
A. Andres
- Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
A.S. Allal
- Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
Ph. Morel
- Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
A.D. Roth
- Department of Oncology, University Hospital of Geneva, Geneva, Switzerland

Accepted 26 September 2007.

Abstract

The review summarises the contributions of chemotherapy, interventional radiology and surgery to the improved survival observed in patients with colorectal liver metastases. The rationale in favour of modern neoadjuvant chemotherapy regimens, of pro-generative manoeuvres to increase the volume of the future remnant liver, and of resection techniques that preserve its function is discussed. For advanced synchronous colorectal metastases, the arguments in favour of a reversed approach with systemic chemotherapy, liver surgery and colon surgery in that order, as opposed to the traditional approach of colon surgery first, or to a simultaneous liver and large bowel resection, are presented.

Keywords: Colorectal liver metastases, Synchronous liver metastases, Liver surgery, Neoadjuvant chemotherapy, Reverse approach