%0 Journal Article
%T Surgical Options for Initially Unresectable Colorectal Liver Metastases
%A Irinel Popescu
%A Sorin Tiberiu Alexandrescu
%J HPB Surgery
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/454026
%X Although the frontiers of liver resection for colorectal liver metastases have broadened in recent decades, approximately 75% of these patients present with unresectable metastases at the time of their diagnosis. In the past, these patients underwent only palliative treatment, without the chance of a cure. In the previous two decades, several therapeutic strategies have been developed that render resectable those metastases that were initially unresectable, thus offering the chance of long-term survival and even a cure to these patients. The oncosurgical modalities that are available include liver resection following portal vein ligation/embolization, ˇ°two-stageˇ± liver resection, one-stage ultrasonically guided liver resection, hepatectomy following conversion chemotherapy, and liver resection combined with thermal ablation. Moreover, in recent years, certain authors have recommended the revisiting of the concept of liver transplantation in highly selected patients with unresectable colorectal liver metastases and favorable prognostic factors. By employing such therapies, the number of patients with colorectal liver metastases who undergo a potentially curative treatment could increase to 40%. The safety profile of these approaches is acceptable (morbidity rates as high as 45%, mortality rates of less than 5%). Furthermore, the 5-year survival rates (approximately 30%) are significantly increased over those that were achieved with palliative treatment. 1. Introduction The current treatment for patients with liver metastases from colorectal cancer is multimodal, including liver resection, chemotherapy, targeted therapies (monoclonal antibodies), interventional radiology, and radiotherapy. The complete resection of liver metastases results in 5-year overall survival rates that range from 21% to 58% [1¨C3], which are significantly higher than those rates that are achieved by nonsurgical therapies (5-year survival rates less than 5%) [4]. Thus, the only potentially curative therapy in patients with colorectal liver metastases (CRLM) includes complete resection of the liver metastases. At present, CRLMs are considered resectable when the following criteria are met [5, 6]:(a)the complete resection of all known disease can be achieved,(b)at least two contiguous liver segments can be preserved, with adequate vascular inflow and outflow, with biliary drainage,(c)the remnant liver volume is adequate to avoid postoperative liver failure. In patients with a healthy liver, the volume of the future liver remnant (FLR) should represent more than 25% of the total liver
%U http://www.hindawi.com/journals/hpb/2012/454026/