Borderline resectable for colorectal liver metastases: Present status and future perspective

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Surgical resection offers the best prognosis for colorectal liver metastases (CRLM), but only 20% are initially resectable.
• Advancements in chemotherapy, interventional radiology, and surgical techniques are expanding CRLM resectability.
• A subset of CRLM are technically resectable but oncologically questionable for upfront surgery, termed borderline resectable.

Purpose of the Study:

• To review the current status and future perspectives of borderline resectable colorectal liver metastases (CRLM).
• To highlight the need for a clear definition and treatment strategy for borderline resectable CRLM, analogous to pancreatic cancer.
• To discuss how clarifying these aspects can further improve prognosis for CRLM patients.

Main Methods:

• Literature review of studies on colorectal liver metastases (CRLM).
• Analysis of factors influencing resectability and prognosis in CRLM.
• Comparison with established definitions and strategies for borderline resectable pancreatic cancer.

Main Results:

• While poor prognostic factors for CRLM are identified, a clear definition and treatment strategy for borderline resectable cases are lacking.
• Multidisciplinary treatment has improved resectability and prognosis for initially unresectable CRLM.
• The concept of 'borderline resectable' is explicit in pancreatic cancer but not yet established for CRLM.

Conclusions:

• Establishing a clear definition and treatment strategy for borderline resectable CRLM is essential for optimizing patient outcomes.
• Further research and consensus are needed to define and manage borderline resectable CRLM effectively.
• Improved management of borderline resectable CRLM has the potential to significantly enhance patient prognosis.