This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chapman, W. C. Articles by Strasberg, S. M. Search for Related Content PubMed PubMed Citation Articles by Chapman, W. C. Articles by Strasberg, S. M.

Selection of Patients for Resection of Hepatic Colorectal Metastases: Expert Consensus Statement by Charnsangavej et al.

¹ Section of Transplantation, Washington University, St. Louis, MO, USA
² Department of Gastrointestinal Medical Oncology, M. D. Anderson Cancer Center, Houston, TX, USA
³ Department of Surgery, Washington University, St. Louis, MO, USA

Correspondence: Address correspondence and reprint requests to: William C. Chapman, MD, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8190, St. Louis, MO 63110, USA, E-mail: chapmanw{at}wustl.edu

Significant advances in imaging techniques have facilitated improved staging for patients with suspected metastatic colorectal cancer over the past 15 years while at the same time surgical techniques have progressed to allow for increasingly complex liver surgery. This combination has lead to dramatic improvements in patient selection for hepatic metastasectomy and reduced the number of patients undergoing nontherapeutic laparotomy. In this regard, patients are now able to undergo complete resection of hepatic colorectal metastases, with long-term survival rates approaching 60% in selected series.¹

[F18]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) imaging has become the gold standard at many institutions for the workup of patients with metastatic colorectal cancer, and often, this is the first study performed following patient referral.² While PET imaging can identify unsuspected intrahepatic metastases, a major advantage lies in identifying unsuspected sites of extrahepatic disease, and on average, this imaging technique has been shown to change management in around 30% of patients. In this regard, many centers now consider FDG-PET imaging a standard imaging test prior to laparotomy for hepatic metastasectomy for colorectal cancer.^3,4

All patients being considered for liver tumor resection should undergo a high-quality contrast-enhanced tomographic assessment of the abdomen prior to laparotomy to define both hepatic and extrahepatic sites of disease and provide anatomic detail for correlation with PET imaging, if performed. Debate persists regarding the relative value of computerized tomography (CT) versus magnetic resonance (MR) imaging in preoperative staging. What remains clear is that the use of CT and MR for the workup of meta-static colorectal cancer is heavily influenced by institutional expertise, with center preference often based on the skill and interest of local tomographers. The current review by Charnsangavej et al. demonstrates that CT and MR, when performed optimally with intravenous (IV) contrast, appear to be equivalent for assessment of hepatic metastases. However, CT appears to be somewhat more accurate than MR for detection of extrahepatic disease.

Prognostic models can predict the outcome of hepatic metastasectomy and facilitate selection of low-risk and high-risk patients for treatment failure and disease recurrence following such resection. However, even among patients with increased risk of future tumor recurrence, aggressive resection strategies have resulted in long-term survival.^1,5 In this regard, most liver surgeons support consideration of hepatic resection in any patient with hepatic colorectal metastases as long as a margin-negative resection is achievable with adequate remnant liver volume with sufficient vascular supply and biliary drainage.⁶ Recent strategies, including neoadjuvant chemotherapy for tumor downstaging, preoperative portal vein embolization to induce hypertrophy of the future liver remnant, and staged resections are techniques that may allow margin-negative resection in patients that in years past would have been considered unresectable.

FOOTNOTES

Proceedings of the Consensus Conference sponsored by the American Hepato-Pancreato-Biliary Association and Co-Sponsored by The Society for Surgery of the Alimentary Tract and The Society of Surgical Oncology held in San Francisco, CA, January 25, 2006

Received for publication May 8, 2006. Accepted for publication June 2, 2006.

REFERENCES

1. Abdalla EK, Vauthey JN, Ellis LM, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004; 239(6):818–25.[CrossRef][Medline]
2. Bipat S, van Leeuwen MS, Comans EF, et al. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis—meta-analysis. Radiology 2005; 237(1):123–31.[Abstract/Free Full Text]
3. Kinkel K, Lu Y, Both M, et al. Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology 2002; 224(3):748–56.[Abstract/Free Full Text]
4. Huebner RH, Park KC, Shepherd JE, et al. A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med 2000; 41(7):1177–89.[Abstract/Free Full Text]
5. Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 2002; 235(6):759–66.[CrossRef][Medline]
6. Pawlik TM, Scoggins CR, Zorzi D, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 2005; 241(5): 715–22.[CrossRef][Medline]

This article has been cited by other articles:

				O. A. Catalano, A. H. Singh, R. N. Uppot, P. F. Hahn, C. R. Ferrone, and D. V. Sahani Vascular and Biliary Variants in the Liver: Implications for Liver Surgery RadioGraphics, March 1, 2008; 28(2): 359 - 378. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chapman, W. C. Articles by Strasberg, S. M. Search for Related Content PubMed PubMed Citation Articles by Chapman, W. C. Articles by Strasberg, S. M.