Liver disease with extrahepatic peritoneal disease

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Metastatic colorectal cancer (CRC) guidelines now include peritoneal disease (PM).
• Concurrent liver and peritoneal metastases (PM) indicate aggressive disease with poor prognosis.
• Historically, PM excluded patients from liver resection, limiting treatment to systemic therapy.

Purpose of the Study:

• To review evolving treatment strategies for colorectal cancer with liver and peritoneal metastases.
• To highlight the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in selected patients.
• To emphasize careful patient selection for combined liver-directed therapy and CRS/HIPEC.

Main Methods:

• Systematic review of contemporary evidence.
• Analysis of treatment outcomes for CRS/HIPEC combined with liver-directed therapy.
• Synthesis of data on patient selection criteria for combined modality treatment.

Main Results:

• Combined CRS/HIPEC and liver-directed therapy can offer significant survival benefits in carefully selected patients.
• Advances in systemic therapy, CRS, and HIPEC are changing the treatment paradigm.
• Patient selection requires meticulous multidisciplinary decision-making.

Conclusions:

• Surgical intervention with CRS/HIPEC and liver-directed therapy is a viable option for select patients with metastatic CRC and concurrent liver/peritoneal disease.
• Careful patient selection is paramount for successful outcomes.
• Multidisciplinary collaboration is essential for optimizing treatment strategies.