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Updated: Aug 29, 2025
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Application of Laparoscopic Hepatectomy Combined with Intraoperative Microwave Ablation in Colorectal Cancer Liver Metastasis
Published on: March 3, 2023
511
Precision surgery for colorectal liver metastases: Current knowledge and future perspectives.
Georgios Antonios Margonis1,2, Jean-Nicolas Vauthey3
1Department of Surgery Memorial Sloan Kettering Cancer Center New York New York USA.
Annals of Gastroenterological Surgery
|September 12, 2022
Summary
Biomarkers like BRAF and KRAS mutations are improving patient selection for colorectal liver metastases surgery. However, combining these with clinical factors is needed for better oncological outcomes.
Area of Science:
- Surgical Oncology
- Genetics
- Hepatobiliary Surgery
Background:
- Patient selection for colorectal liver metastases (CRLM) surgery is crucial for optimal outcomes.
- Previous reliance on clinical risk scores for patient selection has proven insufficient.
- Biomarkers are increasingly integrated into strategies for selecting patients for CRLM surgery.
Purpose of the Study:
- To review current and emerging strategies for patient selection in CRLM surgery, focusing on the role of biomarkers.
- To evaluate the utility of specific genetic mutations (BRAF, KRAS, TP53, SMAD4) in guiding surgical decisions.
- To assess the refined criteria for selecting patients for specialized procedures like two-stage hepatectomy (TSH), Associating Liver Partition and Portal vein Ligation for staged hepatectomy (ALPPS), and liver transplant (LT).
Main Methods:
- Review of literature on patient selection for CRLM surgery, emphasizing biomarker integration.
- Analysis of specific genetic mutations (BRAF V600E, KRAS G12V, RAS, TP53, SMAD4) and their prognostic significance.
- Examination of criteria for selecting patients for single-stage hepatectomy and complex staged procedures (TSH, ALPPS, LT).
Main Results:
- BRAF V600E, KRAS G12V, and triple mutations (RAS, TP53, SMAD4) are promising biomarkers but not definitive contraindications alone.
- Combining biomarkers with clinicopathologic factors may improve patient selection, requiring external validation.
- BRAF mutations and right-sided tumor laterality are proposed contraindications for LT.
- Right-sided laterality, especially with RAS mutations, is associated with poor outcomes in ALPPS.
- RAS mutations may indicate poor survival in TSH and could guide TSH selection.
- Right-sided tumors with RAS mutations may contraindicate LT and ALPPS.
Conclusions:
- Biomarker-driven patient selection is refining CRLM surgical strategies.
- Specific mutations and tumor locations influence the choice and contraindications for different surgical approaches (hepatectomy, TSH, ALPPS, LT).
- Further research is needed for robust validation and integration of biomarkers into clinical decision-making for CRLM management.
