Surgical resection of metastatic cancer to the liver

Resection and local therapy for liver metastases

In 30-50% of patients the liver is a preferred site of distant disease for many malignant tumours. Due to the high incidence, most of the available data relate to metastases arising from colorectal primaries. Surgical resection is at present the only treatment offering potential cure. The achievable 5-year survival rate is 30%. However, only 10-15% of patients with colorectal liver metastases can undergo potentially curative liver resection. Therefore, accurate staging is an important prerequisite in selecting patients who would benefit from surgery. Recurrence of hepatic metastases after potentially curative resection occurs in up to 60% of the cases. Results demonstrate that re-resection of liver metastases can provide long-term survival rates in a carefully selected group of patients without extrahepatic disease. Because of the high rate of recurrences following an apparently curative resection several authors investigated the use of adjuvant chemotherapy (systemic, intraportal, and hepatic arterial infusion). Until recently none had shown effectiveness. Pre-operative chemotherapy seems to be a promising approach in patients with liver metastases initially considered unsuitable for radical surgery. Recently, neoadjuvant chemotherapy has been proposed as an alternative approach to conventional surgery as initial management with the aim of improving the results in resectable liver metastases. Interventional strategies (ethanol injection, cryosurgery, laser-induced thermotherapy, radio-frequency ablation) and combined modalities (surgical/interventional) are additive methods which may help to improve treatment results in the future.

The value of tumor markers in colorectal cancer

Currently CEA is the most accurate tumor marker for colorectal cancer. Preoperative determination of this marker can assist staging, treatment planning and in particular postoperative follow-up of colorectal cancer. Postoperative CEA monitoring should be performed every 3 months. Further evaluation for local recurrence or metastatic disease is mandatory if elevated or increasing CEA levels occur after radical surgery. However, present data do not justify using CEA alone for postoperative follow-up and monitoring of adjuvant therapy. Molecular genetic techniques are now increasingly performed to detect genetic alterations that can be used as prognostic markers. In the future, identification and quantification of these genes may even be valuable in defining the susceptibility of healthy individuals for colorectal cancer.