Liver surgery for the treatment of colorectal liver metastases is the standard treatment in a dynamic surgical field with many variables that should be considered in a curative intent scenario. Hepatectomy for colorec...Liver surgery for the treatment of colorectal liver metastases is the standard treatment in a dynamic surgical field with many variables that should be considered in a curative intent scenario. Hepatectomy for colorectal liver metastases has undergone constant changes over the last 30 years, including indications until the need for rescue procedures of recurrent and advanced diseases as well as minimally invasive surgery. These advancements in liver surgery have not only resulted from overall improvements in the surgical field but have also resulted from a better understanding of the biological behavior of the disease, liver regeneration, and homeostasis during and after surgery.Improvements in anesthesiology, intensive care medicine, radiology, and surgical devices have correlated with further advancements of hepatectomies. Moreover,changes are still forthcoming, and both fields of augmented reality and artificial intelligence will likely have future contributions in this field in regard to both diagnoses and the planning of procedures. The aim of this editorial is to emphasize several aspects that have contributed to the paradigm shifts in colorectal liver metastases surgery over the last three decades as well as to discuss the factors concerning patient selection and the technical aspects of liver surgery. Finally, this editorial will highlight the promising new features of this surgery for diagnoses and treatments in this field.展开更多
Colorectal cancer represents the third most diagnosed malignancy in the world.The liver is the main site of metastatic disease,affected in 30%of patients with newly diagnosed disease.Complete resection is considered t...Colorectal cancer represents the third most diagnosed malignancy in the world.The liver is the main site of metastatic disease,affected in 30%of patients with newly diagnosed disease.Complete resection is considered the only potentially curative treatment for colorectal liver metastasis(CRLM),with a 5-year survival rate ranging from 35%to 58%.However,up to 80%of patients have initially unresectable disease,due to extrahepatic disease or bilobar multiple liver nodules.The availability of increasingly effective systemic chemotherapy has contributed to converting patients with initially unresectable liver metastases to resectable disease,improving long-term outcomes,and accessing tumor biology.In recent years,response to preoperative systemic chemotherapy before liver resection has been established as a major prognostic factor.Some studies have demonstrated that patients with regression of hepatic metastases while on chemotherapy have improved outcomes when compared to patients with stabilization or progression of the disease.Even if disease progression during chemotherapy represents an independent negative prognostic factor,some patients may still benefit from surgery,given the role of this modality as the main treatment with curative intent for patients with CRLM.In selected cases,based on size,the number of lesions,and tumor markers,surgery may be offered despite the less favorable prognosis and as an option for non-chemo responders.展开更多
文摘Liver surgery for the treatment of colorectal liver metastases is the standard treatment in a dynamic surgical field with many variables that should be considered in a curative intent scenario. Hepatectomy for colorectal liver metastases has undergone constant changes over the last 30 years, including indications until the need for rescue procedures of recurrent and advanced diseases as well as minimally invasive surgery. These advancements in liver surgery have not only resulted from overall improvements in the surgical field but have also resulted from a better understanding of the biological behavior of the disease, liver regeneration, and homeostasis during and after surgery.Improvements in anesthesiology, intensive care medicine, radiology, and surgical devices have correlated with further advancements of hepatectomies. Moreover,changes are still forthcoming, and both fields of augmented reality and artificial intelligence will likely have future contributions in this field in regard to both diagnoses and the planning of procedures. The aim of this editorial is to emphasize several aspects that have contributed to the paradigm shifts in colorectal liver metastases surgery over the last three decades as well as to discuss the factors concerning patient selection and the technical aspects of liver surgery. Finally, this editorial will highlight the promising new features of this surgery for diagnoses and treatments in this field.
文摘Colorectal cancer represents the third most diagnosed malignancy in the world.The liver is the main site of metastatic disease,affected in 30%of patients with newly diagnosed disease.Complete resection is considered the only potentially curative treatment for colorectal liver metastasis(CRLM),with a 5-year survival rate ranging from 35%to 58%.However,up to 80%of patients have initially unresectable disease,due to extrahepatic disease or bilobar multiple liver nodules.The availability of increasingly effective systemic chemotherapy has contributed to converting patients with initially unresectable liver metastases to resectable disease,improving long-term outcomes,and accessing tumor biology.In recent years,response to preoperative systemic chemotherapy before liver resection has been established as a major prognostic factor.Some studies have demonstrated that patients with regression of hepatic metastases while on chemotherapy have improved outcomes when compared to patients with stabilization or progression of the disease.Even if disease progression during chemotherapy represents an independent negative prognostic factor,some patients may still benefit from surgery,given the role of this modality as the main treatment with curative intent for patients with CRLM.In selected cases,based on size,the number of lesions,and tumor markers,surgery may be offered despite the less favorable prognosis and as an option for non-chemo responders.
