Kitano Y, Hayashi H, Matsumoto T, Kinoshita S, Sato H, Shiraishi Y, Nakao Y, Kaida T, Imai K, Yamashita YI, Baba H. Borderline resectable for colorectal liver metastases: Present status and future perspective. World J Gastrointest Surg 2021; 13(8): 756-763 [PMID: 34512899 DOI: 10.4240/wjgs.v13.i8.756]
Corresponding Author of This Article
Hiromitsu Hayashi, FACS, MD, PhD, Assistant Professor, Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Kumamoto 860-8556, Japan. hhayasi@kumamoto-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yuki Kitano, Hiromitsu Hayashi, Takashi Matsumoto, Shotaro Kinoshita, Hiroki Sato, Yuta Shiraishi, Yosuke Nakao, Takayoshi Kaida, Katsunori Imai, Yo-ichi Yamashita, Hideo Baba, Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
Author contributions: Kitano Y, Hayashi H, Imai K, Yamashita YI and Baba H contributed conception and design; Kitano Y, Hayashi H, Matsumto T, Kinoshita S, Sato H, Shiraishi Y, Nakao Y, Kaida T, Imai K, Yamashita YI, and Baba H contributed writing, review, and/or revision of the manuscript; Kitano Y, Hayashi H, Imai K, Yamashita YI, and Baba H contributed study supervision.
Conflict-of-interest statement: No conflict of interest exists in this study.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hiromitsu Hayashi, FACS, MD, PhD, Assistant Professor, Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Kumamoto 860-8556, Japan. hhayasi@kumamoto-u.ac.jp
Received: January 12, 2021 Peer-review started: January 12, 2021 First decision: March 30, 2021 Revised: April 6, 2021 Accepted: July 6, 2021 Article in press: July 6, 2021 Published online: August 27, 2021 Processing time: 219 Days and 19.5 Hours
Abstract
Surgical resection for colorectal liver metastases (CRLM) may offer the best opportunity to improve prognosis. However, only about 20% of CRLM cases are indicated for resection at the time of diagnosis (initially resectable), and the remaining cases are treated as unresectable (initially unresectable). Thanks to recent remarkable developments in chemotherapy, interventional radiology, and surgical techniques, the resectability of CRLM is expanding. However, some metastases are technically resectable but oncologically questionable for upfront surgery. In pancreatic cancer, such cases are categorized as “borderline resectable”, and their definition and treatment strategies are explicit. However, in CRLM, although various poor prognosis factors have been identified in previous reports, no clear definition or treatment strategy for borderline resectable has yet been established. Since the efficacy of hepatectomy for CRLM was reported in the 1970s, multidisciplinary treatment for unresectable cases has improved resectability and prognosis, and clarifying the definition and treatment strategy of borderline resectable CRLM should yield further improvement in prognosis. This review outlines the present status and the future perspective for borderline resectable CRLM, based on previous studies.
Core Tip: At this stage, a clear definition and treatment policy for borderline resectable colorectal liver metastases has not been established. According to previous reports, borderline resectable for colorectal liver metastases is oncologically highly malignant (simultaneous liver metastasis, multiple tumors, large tumor diameter, high level of carcinoembryonic antigen, extrahepatic lesions) or technically difficult (necessity of special procedures such as radiofrequency ablation, portal vein embolization, two-stage hepatectomy, and associating liver partition and portal vein ligation for staged hepatectomy for R0 resection or close to the main vessel), and hepatectomy after preoperative adjuvant chemotherapy is recommended as a treatment policy.
