Oncosurgery: a new reality in metastatic colorectal carcinoma

Surgery is the only curative option for the treatment of liver metastases from colorectal cancer. However, fewer than 25% of hepatic metastases are suitable for resection and as many as 70% of these will recur. A variety of factors have been identified as significant predictors of long-term survival following hepatic resection, and improved surgical techniques such as cryosurgery, radiofrequency ablation, portal vein embolization, and two-stage hepatectomy have been developed to overcome some of the negative factors that contribute to poor prognosis. Whereas adjunctive 5-fluorouracil-based chemotherapy has had little impact on outcome, the new platinum derivative oxaliplatin added to 5-fluorouracil plus leucovorin has improved time-dependent parameters of efficacy and successfully downstaged the disease in some patients with unresectable metastases. In a recent study in 389 such patients, 151 of which had liver-only metastases, 51% treated with oxaliplatin became resectable with some patients achieving a complete histologic response. In another series of 95 initially unresectable patients who became resectable after treatment with oxaliplatin-based therapy, 41% were still alive after 4.2 years, with 64% of these being recurrence-free. Postoperative chemotherapeutic regimes have also been developed to eliminate residual disease after surgery; however, the advantage of preoperative chemotherapy is the potential to achieve a conversion from unresectability to resectability of hepatic metastases from primary colorectal cancer.