John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Potentially resectable colorectal liver metastases Volume 17, special issue 5, Cancer colorectal : acquis thérapeutiques récents

Hôpital Haut-Lévêque service de chirurgie digestive groupe hospitalier Sud CHU de Bordeaux avenue de Magellan 33604 Pessac France

At diagnosis of colorectal liver metastases (CRLM), only 10 to 20% of patients have CRLM deemed resectable. Nowadays, the non-resectability is defined by the inability to completely remove all CRLM while leaving at least 30% of remnant normal functioning liver parenchyma. The improvement of the effectiveness of chemotherapy regimens and the development of targeted therapies have not only increased the survival of patients with unresectable CRLM, but also allowed to consider secondary surgery — the only hope for prolonged survival — for a greater number of patients with initially unresectable CRLM. In addition, the development of new surgical techniques (portal embolization, two-stage hepatectomy and ablathermy) has increased the number of patients in whom it is possible to achieve complete resection (R0) of CLRM while maintaining a sufficient residual functional liver volume to avoid postoperative liver failure. The initial management of patients with unresectable CRLM requires a multidisciplinary assessment at each stage of treatment, in order to identify patients with potentially resectable CRLM, and to define and adapt the therapeutic strategy.