Asset Details
Do you wish to reserve the book?
Management of colorectal cancer presenting with synchronous liver metastases
Hey, we have placed the reservation for you!
By the way, why not check out events that you can attend while you pick your title.
Oops! Something went wrong.
Looks like we were not able to place the reservation. Kindly try again later.
Are you sure you want to remove the book from the shelf?
Management of colorectal cancer presenting with synchronous liver metastases
Do you wish to request the book?
Management of colorectal cancer presenting with synchronous liver metastases
Please be aware that the book you have requested cannot be checked out. If you would like to checkout this book, you can reserve another copy
We have requested the book for you!
Your request is successful and it will be processed during the Library working hours. Please check the status of your request in My Requests.
Oops! Something went wrong.
Looks like we were not able to place your request. Kindly try again later.
Journal Article
Management of colorectal cancer presenting with synchronous liver metastases
2014
Overview
Key Points
Up to a 20% of patients with colorectal cancer (CRC) present with synchronous hepatic metastases
In patients who present without intestinal obstruction or perforation, comprehensive whole-body imaging is required to exclude extrahepatic disease
Current evidence indicates a state of equipoise between several different management approaches for the treatment of CRC and synchronous liver metastatic disease, none of which has supportive randomized trial evidence
Neoadjuvant systemic chemotherapy is supported by current guidelines and can result in tumour downsizing, enabling some 'unresectable' liver metastases to be surgically removed
Surgery can take the form of the 'classic' approach (colorectal resection, then interval chemotherapy followed by liver resection), synchronous removal of liver and bowel tumours, or a liver-first approach
Clear superiority has not been demonstrated for any of these surgical interventions for CRC with synchronous liver metastases, although the mode of presentation can determine the approach used
Around 20% of patients with colorectal cancer (CRC) have synchronous hepatic metastases at the time of presentation, highlighting the need for appropriate diagnostic and staging assessments. Furthermore, various approaches to the therapeutic management of such patients are available, and the treatment strategy used is influenced by clinical presentation. Herein, these aspects of the management of patients with CRC and synchronous liver metastases are comprehensively reviewed, focusing on the integration of surgical approaches within a multidisciplinary framework.
Up to a fifth of patients with colorectal cancer (CRC) present with synchronous hepatic metastases. In patients with CRC who present without intestinal obstruction or perforation and in whom comprehensive whole-body imaging confirms the absence of extrahepatic disease, evidence indicates a state of equipoise between several different management pathways, none of which has demonstrated superiority. Neoadjuvant systemic chemotherapy is advocated by current guidelines, but must be integrated with surgical management in order to remove the primary tumour and liver metastatic burden. Surgery for CRC with synchronous liver metastases can take a number of forms: the 'classic' approach, involving initial colorectal resection, interval chemotherapy and liver resection as the final step; simultaneous removal of the liver and bowel tumours with neoadjuvant or adjuvant chemotherapy; or a 'liver-first' approach (before or after systemic chemotherapy) with removal of the colorectal tumour as the final procedure. In patients with rectal primary tumours, the liver-first approach can potentially avoid rectal surgery in patients with a complete response to chemoradiotherapy. We overview the importance of precise nomenclature, the influence of clinical presentation on treatment options, and the need for accurate, up-to-date surgical terminology, staging tests and contemporary management options in CRC and synchronous hepatic metastatic disease, with an emphasis on multidisciplinary care.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
