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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jun 10, 2017; 8(3): 190-202
Published online Jun 10, 2017. doi: 10.5306/wjco.v8.i3.190
Multidisciplinary approach of colorectal cancer liver metastases
Giammaria Fiorentini, Donatella Sarti, Camillo Aliberti, Riccardo Carandina, Andrea Mambrini, Stefano Guadagni
Giammaria Fiorentini, Donatella Sarti, Onco-Ematology Department, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, 61122 Pesaro, Italy
Camillo Aliberti, Riccardo Carandina, Oncology Radiodiagnostics Department, Oncology Institute of Veneto, Institute for the Research and Treatment of Cancer, 35128 Padova, Italy
Andrea Mambrini, Oncology Department, Carrara General Hospital, 54033 Carrara, Italy
Stefano Guadagni, Department of Applied Clinical Sciences and Biotechnology, Section of General Surgery, University of L’Aquila, 67100 L’Aquila, Italy
Author contributions: Fiorentini G and Sarti D wrote the paper and made tables and figures; Aliberti C, Carandina R, Mambrini A and Guadagni S collected the data.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: 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/
Correspondence to: Dr. Giammaria Fiorentini, Onco-Ematology Department, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, Via Lombroso 1, 61122 Pesaro, Italy. g.fiorentini@alice.it
Telephone: +39-0721-364005 Fax: +39-0721-364094
Received: January 20, 2017
Peer-review started: January 20, 2017
First decision: March 27, 2017
Revised: April 27, 2017
Accepted: May 3, 2017
Article in press: May 4, 2017
Published online: June 10, 2017
Processing time: 133 Days and 4.8 Hours
Abstract

Large bowel cancer is a worldwide public health challenge. More than one third of patients present an advanced stage of disease at diagnosis and the liver is the most common site of metastases. Selection criteria for early diagnosis, chemotherapy and surgery have been recently expanded. The definition of resectability remains unclear. The presence of metastases is the most significant prognostic factor. For this reason the surgical resection of hepatic metastases is the leading treatment. The most appropriate resection approach remains to be defined. The two step and simultaneous resection processes of both primary and metastases have comparable survival long-term outcomes. The advent of targeted biological chemotherapeutic agents and the development of loco-regional therapies (chemoembolization, thermal ablation, arterial infusion chemotherapy) contribute to extend favorable results. Standardized evidence-based protocols are missing, hence optimal management of hepatic metastases should be single patient tailored and decided by a multidisciplinary team. This article reviews the outcomes of resection, systemic and loco-regional therapies of liver metastases originating from large bowel cancer.

Keywords: Colorectal cancer; Chemoembolization; Liver metastases; Hepatic resection; Colorectal cancer liver metastases; Chemotherapy; Arterial infusion chemotherapy; Radioembolization

Core tip: Improvements of colorectal cancer liver metastases (CRC-LM) treatment allows the down-staging of several patients. There is currently no agreement in the correct sequence of surgical resection of the primary cancer and metastatic disease. Surgical resection can be performed if the complete removal of cancer is achievable, leaving an adequate normal liver tissue. Neoadjuvant chemotherapy is widely accepted as primary therapy. Chemotherapy may lead to disease regression for unresectable CRC-LM, allowing resection and cure. The application of loco-regional therapies is increasing. They are recommended as third-line treatment for unresectable CRC-LM and have a palliative intent.