AIM: To offer an up-to-date review of all available treatment strategies for patients with synchronous colorectal liver metastases (CLM). METHODS: A comprehensive literature search was performed to identify articles related to the management of patients with synchronous CLM. A search of the electronic databases PubMed, MEDLINE, and Google Scholar was conducted in September 2014. The following search terms were used: synchronous colorectal liver metastases, surgery, stage IV colorectal cancer, liver-first approach, and up-front hepatectomy. These terms were employed in various combinations to maximize the search. Only articles written in English were included. Particular attention was devoted to studies and review articles that were published within the last six years (2009-2014). Additional searches of the cited references from primary articles were performed to further improve the review. The full texts of all relevant articles were accessed by two independent reviewers. RESULTS: Poor long-term outcomes of patients with synchronous CLM managed by a traditional treatment strategy have led to questions about the timing and sequence of possible therapeutic interventions. Thus, alternative paradigms called reverse strategies have been proposed. Presently, there are four treatment strategies available: (1) primary first approach (or traditional approach) comprises resection of the primary colorectal tumor followed by chemotherapy; subsequent liver resection is performed 3-6 mo after colorectal resection (provided that CLM are still resectable); (2) simultaneous resection of the primary colorectal tumor and CLM during a single operation presents intriguing options for a highly select group of patients, which can be associated with significant postoperative morbidity; (3) liver-first (or chemotherapy-first) approach comprises preoperative chemotherapy (3-6 cycles) followed by liver resection, adjuvant chemotherapy, and resection of the primary colorectal tumor (it is best suited for patients with asymptomatic primary tumors and initially unresectable or marginally resectable CLM); and (4) up-front hepatectomy (or "true" liver-first approach) includes liver resection followed by adjuvant chemotherapy, colorectal resection, and adjuvant chemotherapy (strategy can be offered to patients with asymptomatic primary tumors and initially resectable CLM). CONCLUSION: None of the aforementioned strategies appears inferior. It is necessary to establish individual treatment plans in multidisciplinary team meetings through careful appraisal of all strategies.

Peter Ihnát Petr Vávra Pavel Zonča Department of Surgical Studies Faculty of Medicine University of Ostrava Ostrava 70300 Czech Republic

Zobrazit více v PubMed

McMillan DC, McArdle CS. Epidemiology of colorectal liver metastases. Surg Oncol. 2007;16:3–5. PubMed

Tsai MS, Su YH, Ho MC, Liang JT, Chen TP, Lai HS, Lee PH. Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastasis. Ann Surg Oncol. 2007;14:786–794. PubMed

Mentha G, Roth AD, Terraz S, Giostra E, Gervaz P, Andres A, Morel P, Rubbia-Brandt L, Majno PE. ‘Liver first’ approach in the treatment of colorectal cancer with synchronous liver metastases. Dig Surg. 2008;25:430–435. PubMed

De Rosa A, Gomez D, Brooks A, Cameron IC. “Liver-first” approach for synchronous colorectal liver metastases: is this a justifiable approach? J Hepatobiliary Pancreat Sci. 2013;20:263–270. PubMed

Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier AM. Epidemiology and management of liver metastases from colorectal cancer. Ann Surg. 2006;244:254–259. PubMed PMC

Van den Eynde M, Hendlisz A. Treatment of colorectal liver metastases: a review. Rev Recent Clin Trials. 2009;4:56–62. PubMed

Giuliante F, Ardito F, Vellone M, Ranucci G, Federico B, Giovannini I, Nuzzo G. Role of the surgeon as a variable in long-term survival after liver resection for colorectal metastases. J Surg Oncol. 2009;100:538–545. PubMed

Ito H, Are C, Gonen M, D’Angelica M, Dematteo RP, Kemeny NE, Fong Y, Blumgart LH, Jarnagin WR. Effect of postoperative morbidity on long-term survival after hepatic resection for metastatic colorectal cancer. Ann Surg. 2008;247:994–1002. PubMed

Farid SG, Aldouri A, Morris-Stiff G, Khan AZ, Toogood GJ, Lodge JP, Prasad KR. Correlation between postoperative infective complications and long-term outcomes after hepatic resection for colorectal liver metastasis. Ann Surg. 2010;251:91–100. PubMed

Andres A, Toso C, Adam R, Barroso E, Hubert C, Capussotti L, Gerstel E, Roth A, Majno PE, Mentha G. A survival analysis of the liver-first reversed management of advanced simultaneous colorectal liver metastases: a LiverMetSurvey-based study. Ann Surg. 2012;256:772–778; discussion 778-779. PubMed

Straka M, Skrovina M, Soumarova R, Kotasek R, Burda L, Vojtek C. Up front hepatectomy for metastatic rectal carcinoma - reversed, liver first approach. Early experience with 15 patients. Neoplasma. 2014;61:447–452. PubMed

Brouquet A, Mortenson MM, Vauthey JN, Rodriguez-Bigas MA, Overman MJ, Chang GJ, Kopetz S, Garrett C, Curley SA, Abdalla EK. Surgical strategies for synchronous colorectal liver metastases in 156 consecutive patients: classic, combined or reverse strategy? J Am Coll Surg. 2010;210:934–941. PubMed

Fahy BN, Fischer CP. Synchronous resection of colorectal primary and hepatic metastasis. J Gastrointest Oncol. 2012;3:48–58. PubMed PMC

Grundmann RT. Current state of surgical treatment of liver metastases from colorectal cancer. World J Gastrointest Surg. 2011;3:183–196. PubMed PMC

de Haas RJ, Adam R, Wicherts DA, Azoulay D, Bismuth H, Vibert E, Salloum C, Perdigao F, Benkabbou A, Castaing D. Comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases. Br J Surg. 2010;97:1279–1289. PubMed

Tsoulfas G, Pramateftakis MG. Management of rectal cancer and liver metastatic disease: which comes first? Int J Surg Oncol. 2012;2012:196908. PubMed PMC

Jegatheeswaran S, Mason JM, Hancock HC, Siriwardena AK. The liver-first approach to the management of colorectal cancer with synchronous hepatic metastases: a systematic review. JAMA Surg. 2013;148:385–391. PubMed

Lehmann K, Rickenbacher A, Weber A, Pestalozzi BC, Clavien PA. Chemotherapy before liver resection of colorectal metastases: friend or foe? Ann Surg. 2012;255:237–247. PubMed

Benoist S, Brouquet A, Penna C, Julié C, El Hajjam M, Chagnon S, Mitry E, Rougier P, Nordlinger B. Complete response of colorectal liver metastases after chemotherapy: does it mean cure? J Clin Oncol. 2006;24:3939–3945. PubMed

Poultsides GA, Servais EL, Saltz LB, Patil S, Kemeny NE, Guillem JG, Weiser M, Temple LK, Wong WD, Paty PB. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol. 2009;27:3379–3384. PubMed PMC

Scheer MG, Sloots CE, van der Wilt GJ, Ruers TJ. Management of patients with asymptomatic colorectal cancer and synchronous irresectable metastases. Ann Oncol. 2008;19:1829–1835. PubMed

Adam R, De Gramont A, Figueras J, Guthrie A, Kokudo N, Kunstlinger F, Loyer E, Poston G, Rougier P, Rubbia-Brandt L, et al. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist. 2012;17:1225–1239. PubMed PMC

Lykoudis PM, O’Reilly D, Nastos K, Fusai G. Systematic review of surgical management of synchronous colorectal liver metastases. Br J Surg. 2014;101:605–612. PubMed

Verhoef C, van der Pool AE, Nuyttens JJ, Planting AS, Eggermont AM, de Wilt JH. The “liver-first approach” for patients with locally advanced rectal cancer and synchronous liver metastases. Dis Colon Rectum. 2009;52:23–30. PubMed

de Jong MC, van Dam RM, Maas M, Bemelmans MH, Olde Damink SW, Beets GL, Dejong CH. The liver-first approach for synchronous colorectal liver metastasis: a 5-year single-centre experience. HPB (Oxford) 2011;13:745–752. PubMed PMC

Grundmann RT, Hermanek P, Merkel S, Germer CT, Grundmann RT, Hauss J, Henne-Bruns D, Herfarth K, Hermanek P, Hopt UT, et al. [Diagnosis and treatment of colorectal liver metastases - workflow] Zentralbl Chir. 2008;133:267–284. PubMed

Neumann UP, Seehofer D, Neuhaus P. The surgical treatment of hepatic metastases in colorectal carcinoma. Dtsch Arztebl Int. 2010;107:335–342. PubMed PMC

Khan K, Wale A, Brown G, Chau I. Colorectal cancer with liver metastases: neoadjuvant chemotherapy, surgical resection first or palliation alone? World J Gastroenterol. 2014;20:12391–12406. PubMed PMC

Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, Bechstein WO, Primrose JN, Walpole ET, Finch-Jones M, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371:1007–1016. PubMed PMC

Morris-Stiff G, Tan YM, Vauthey JN. Hepatic complications following preoperative chemotherapy with oxaliplatin or irinotecan for hepatic colorectal metastases. Eur J Surg Oncol. 2008;34:609–614. PubMed

Zorzi D, Laurent A, Pawlik TM, Lauwers GY, Vauthey JN, Abdalla EK. Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg. 2007;94:274–286. PubMed

Khan AZ, Morris-Stiff G, Makuuchi M. Patterns of chemotherapy-induced hepatic injury and their implications for patients undergoing liver resection for colorectal liver metastases. J Hepatobiliary Pancreat Surg. 2009;16:137–144. PubMed

Karoui M, Penna C, Amin-Hashem M, Mitry E, Benoist S, Franc B, Rougier P, Nordlinger B. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg. 2006;243:1–7. PubMed PMC

Mentha G, Terraz S, Morel P, Andres A, Giostra E, Roth A, Rubbia-Brandt L, Majno P. Dangerous halo after neoadjuvant chemotherapy and two-step hepatectomy for colorectal liver metastases. Br J Surg. 2009;96:95–103. PubMed

Tanaka K, Takakura H, Takeda K, Matsuo K, Nagano Y, Endo I. Importance of complete pathologic response to prehepatectomy chemotherapy in treating colorectal cancer metastases. Ann Surg. 2009;250:935–942. PubMed

Adam R, Wicherts DA, de Haas RJ, Ciacio O, Lévi F, Paule B, Ducreux M, Azoulay D, Bismuth H, Castaing D. Patients with initially unresectable colorectal liver metastases: is there a possibility of cure? J Clin Oncol. 2009;27:1829–1835. PubMed

Stein A, Schmoll HJ. Systemic treatment of liver metastases from colorectal cancer. Ther Adv Med Oncol. 2013;5:193–203. PubMed PMC

Adam R, Bhangui P, Poston G, Mirza D, Nuzzo G, Barroso E, Ijzermans J, Hubert C, Ruers T, Capussotti L, et al. Is perioperative chemotherapy useful for solitary, metachronous, colorectal liver metastases? Ann Surg. 2010;252:774–787. PubMed

Reddy SK, Zorzi D, Lum YW, Barbas AS, Pawlik TM, Ribero D, Abdalla EK, Choti MA, Kemp C, Vauthey JN, et al. Timing of multimodality therapy for resectable synchronous colorectal liver metastases: a retrospective multi-institutional analysis. Ann Surg Oncol. 2009;16:1809–1819. PubMed

Lubezky N, Geva R, Shmueli E, Nakache R, Klausner JM, Figer A, Ben-Haim M. Is there a survival benefit to neoadjuvant versus adjuvant chemotherapy, combined with surgery for resectable colorectal liver metastases? World J Surg. 2009;33:1028–1034. PubMed

Zhu D, Zhong Y, Wei Y, Ye L, Lin Q, Ren L, Ye Q, Liu T, Xu J, Qin X. Effect of neoadjuvant chemotherapy in patients with resectable colorectal liver metastases. PLoS One. 2014;9:e86543. PubMed PMC

Nanji S, Cleary S, Ryan P, Guindi M, Selvarajah S, Al-Ali H, Grieg P, McGilvary I, Taylor B, Wei A, et al. Up-front hepatic resection for metastatic colorectal cancer results in favorable long-term survival. Ann Surg Oncol. 2013;20:295–304. PubMed

Wieser M, Sauerland S, Arnold D, Schmiegel W, Reinacher-Schick A. Peri-operative chemotherapy for the treatment of resectable liver metastases from colorectal cancer: A systematic review and meta-analysis of randomized trials. BMC Cancer. 2010;10:309. PubMed PMC

Chua TC, Saxena A, Liauw W, Kokandi A, Morris DL. Systematic review of randomized and nonrandomized trials of the clinical response and outcomes of neoadjuvant systemic chemotherapy for resectable colorectal liver metastases. Ann Surg Oncol. 2010;17:492–501. PubMed

Stereotactic body radiotherapy using the CyberKnife® system in the treatment of patients with liver metastases: state of the art

Medical Image Retrieval Using Vector Quantization and Fuzzy S-tree