John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Evolution of the treatment of colorectal liver metastases: toward a definition of parenchyma saving procedures Volume 25, issue 3, Mars 2018

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Institut Bergonié, Université de Bordeaux, ESSO/EORTC, 229 cours de l’Argonne 33076 Bordeaux Cedex, France
* Tirés à part
  • Key words: colorectal liver metastasis, hepatectomy, ablation, portal vein obliteration, induction chemotherapy
  • DOI : 10.1684/hpg.2018.1588
  • Page(s) : 248-55
  • Published in: 2018

Colorectal liver metastases (CRLM) have been the focus for surgery in the treatment of metastatic disease, an abnormal domain for it initially. The story is a paradigm of the evolution of surgical oncology: first cautious, it became more and more aggressive before deescalating onto specific targets. As is often the case, surgeons were more inspired by technique than biology until they learned that hepatocyte homeostasis also triggers tumor growth. Today, biology offers a new insight into surgical strategies. Only CRLMs are targets and healthy parenchyma should be spared at the best. Remove few to remove several times in a recurrent disease. The use of portal vein obliteration as well as two-stage surgeries must be limited to sole cases with a risk of postoperative liver failure. Thus, the modern surgical treatment of CRLM is a parenchymal sparing surgery, a multidisciplinary approach more compatible with chemotherapy than extensive surgery. In the future, molecular biology will help selecting patients who can benefit from a local treatment.