Management of colorectal liver metastases

Abstract

Colorectal cancer ranks third among all cancers in terms of incidence and second in terms of mortality, accounting for 447,000 new cases and 215,000 deaths in Europe only in 2012. In the same year, there were 1.4 million newly diagnosed cases worldwide and unfortunately 694,000 deaths. The organ, which is most frequently exposed to the dissemination of colorectal cancer cells and develops metastasis, is the liver. The two most commonly used imaging modalities for showing colorectal liver metastases (CRLM) are computed tomography (CT) and magnetic resonance imaging (MRI). Treatment of CRLM requires a multidisciplinary approach. The combination of irinotecan/5-fluorouracil (5-FU)/leucovorin (LV) (FOLFIRI) and the combination of oxaliplatin/5-FU/LV (FOLFOX) are the standard approach method used in the first-line treatment for years. Targeted agents, such as bevacizumab/cetuximab, are now used as a standard in the combination with chemotherapy for patients with K-RAS wild-type. In addition to imaging methods, CRLM treatment planning may be performed much better after adding diagnostic laparoscopy modality. The 5-year overall survival rate in patients with CRLM could increase from 40% to 50-60% with modern surgical and oncological approach owing to the advanced technology and surgical techniques. For unresectable liver metastases, hepatic arterial infusion pump chemotherapy is used at experienced centers, and then, lesions that become resectable with this method may be resected. In unresectable CRLM, if there is no other intra-abdominal and systemic metastatic focus, liver transplantation has become a treatment modality that has been on the agenda more often in recent years. © 2023 Elsevier B.V., All rights reserved.