Bringing unresectable liver disease to resection with curative intent

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Colorectal liver metastases (CLM) often present as unresectable disease, leading to a poor prognosis.
• Complete resection is the only curative option, but is frequently precluded by disease extent.

Purpose of the Study:

• To review current strategies for increasing the resectability of colorectal liver metastases.
• To highlight the role of neoadjuvant chemotherapy and advanced surgical techniques in achieving curative resection.

Main Methods:

• Review of neoadjuvant chemotherapy regimens (e.g., 5-fluorouracil, oxaliplatin, irinotecan) and targeted therapies (cetuximab, bevacizumab).
• Discussion of surgical techniques including portal vein embolization, two-stage hepatectomy, and local ablation.
• Consideration of complex resections involving hepatic veins and inferior vena cava.

Main Results:

• Chemotherapy can downstage liver disease, enabling curative rescue resection and improving survival.
• Targeted therapies may increase resectability rates, expanding surgical candidacy.
• Advanced surgical techniques and vascular reconstruction facilitate resection even with extensive tumor involvement.

Conclusions:

• Neoadjuvant therapy and innovative surgical approaches significantly improve resectability for CLM.
• Multidisciplinary collaboration between oncologists and surgeons is crucial for optimizing treatment strategies and outcomes.