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Missing colorectal liver metastases: the surgical challenge
Elena Ramírez-Maldonado1, Rocío García-Pérez2, Joana Ferrer-Fàbrega2
1General and Digestive Surgery Department - Hospital Clínic, IDIBAPS, CIBERHD, University of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain. elena.ramirezmaldonado@gmail.com.
Langenbeck'S Archives of Surgery
|September 30, 2021
Summary
Managing missing liver metastases (MLM) after chemotherapy for colorectal cancer requires careful consideration. While liver surgery is key, monitoring MLM may be a viable option in some cases, pending further research.
Area of Science:
- Hepatobiliary surgery
- Colorectal cancer management
- Medical oncology
Background:
- Advanced chemotherapy regimens improve radiological response in unresectable colorectal liver metastases, creating scenarios of complete radiological response.
- Missing liver metastases (MLM) present a unique clinical challenge in managing colorectal cancer patients.
- Understanding the optimal strategy for MLM is crucial for improving patient outcomes.
Purpose of the Study:
- To review the current management strategies for missing liver metastases (MLM) from a liver surgeon's perspective.
- To synthesize evidence on the predictive factors and treatment outcomes for MLM.
- To evaluate the role of liver surgery versus monitoring for MLM.
Main Methods:
- Systematic literature search of PubMed and Embase (2003-2018).
- Inclusion of 18 original articles for analysis.
- Meta-analysis performed on resected versus unresected MLM, assessing residual tumor, regrowth, and relapse-free survival.
Main Results:
- Predictive factors for MLM include chemotherapy type/duration and lesion size/number.
- Magnetic resonance imaging (MRI) is the most sensitive preoperative detection technique.
- Liver surgery is considered the cornerstone of MLM management, though meta-analysis was inconclusive due to data heterogeneity.
Conclusions:
- MLM monitoring can be a valid therapeutic alternative depending on the clinical context.
- Further prospective randomized clinical studies are essential to establish definitive guidelines for MLM management.
