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Synchronous colorectal liver metastases: is it time to reconsider traditional paradigms of management?

Publication ,  Journal Article
Reddy, SK; Barbas, AS; Clary, BM
Published in: Ann Surg Oncol
September 2009

BACKGROUND: Patients with synchronous colorectal liver metastases (CLM) are typically treated with initial colorectal resection followed by arbitrary and prolonged courses of chemotherapy. Partial hepatectomy is considered only for patients without interval disease progression. This review describes the rationale for this treatment approach and the recent developments suggesting that this management paradigm should be reconsidered. RESULTS: Because asymptomatic colorectal cancer often does not lead to complications, and given the potential benefit of chemotherapy in downsizing unresectable to resectable liver disease, most patients with asymptomatic primary tumors and unresectable synchronous CLM should be first treated with chemotherapy. In contrast, initial hepatic resection should be considered for resectable synchronous CLM. Survival benefits from prehepatectomy chemotherapy have not been established. Several reports demonstrate morbidity after hepatic resection from extended durations of irinotecan- and/or oxaliplatin-based prehepatectomy chemotherapy. Although shorter treatment periods may not have these deleterious effects on subsequent hepatic resection, prospective studies reveal that most patients with supposedly aggressive disease with short treatment durations will not be identified. Moreover, a complete radiologic response to prehepatectomy chemotherapy is not only rare but also does not equate with a complete pathological response. Finally, several studies suggest that simultaneous colorectal and minor hepatic resections can performed safely with benefits in total morbidity when compared with traditional staged procedures. CONCLUSIONS: The traditional treatment paradigm centering on the utility of prehepatectomy chemotherapy for resectable synchronous CLM should be reconsidered. Recent developments underscore the need for prospective randomized controlled trials evaluating the optimal timing of hepatectomy relative to chemotherapy.

Duke Scholars

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

September 2009

Volume

16

Issue

9

Start / End Page

2395 / 2410

Location

United States

Related Subject Headings

  • Oncology & Carcinogenesis
  • Liver Neoplasms
  • Humans
  • Colorectal Neoplasms
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
 

Citation

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Reddy, S. K., Barbas, A. S., & Clary, B. M. (2009). Synchronous colorectal liver metastases: is it time to reconsider traditional paradigms of management? Ann Surg Oncol, 16(9), 2395–2410. https://doi.org/10.1245/s10434-009-0372-1
Reddy, Srinevas K., Andrew S. Barbas, and Bryan M. Clary. “Synchronous colorectal liver metastases: is it time to reconsider traditional paradigms of management?Ann Surg Oncol 16, no. 9 (September 2009): 2395–2410. https://doi.org/10.1245/s10434-009-0372-1.
Reddy SK, Barbas AS, Clary BM. Synchronous colorectal liver metastases: is it time to reconsider traditional paradigms of management? Ann Surg Oncol. 2009 Sep;16(9):2395–410.
Reddy, Srinevas K., et al. “Synchronous colorectal liver metastases: is it time to reconsider traditional paradigms of management?Ann Surg Oncol, vol. 16, no. 9, Sept. 2009, pp. 2395–410. Pubmed, doi:10.1245/s10434-009-0372-1.
Reddy SK, Barbas AS, Clary BM. Synchronous colorectal liver metastases: is it time to reconsider traditional paradigms of management? Ann Surg Oncol. 2009 Sep;16(9):2395–2410.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

September 2009

Volume

16

Issue

9

Start / End Page

2395 / 2410

Location

United States

Related Subject Headings

  • Oncology & Carcinogenesis
  • Liver Neoplasms
  • Humans
  • Colorectal Neoplasms
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis