J.Jpn. Surg. Soc.. 123(3): 262-269, 2022

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Feature topic

SURGICAL INDICATIONS AND STRATEGY FOR MULTINODULAR COLORECTAL LIVER METASTASES

No randomized controlled trials so far have shown significantly longer overall survival in patients who underwent hepatectomy with preoperative or postoperative adjuvant chemotherapy compared with those who received hepatectomy alone for resectable colorectal liver metastases. However, preoperative chemotherapy has been commonly administered to patients with multinodular disease because the number of metastases is a well-known prognostic predictor. Further, even in patients with advanced liver metastases, the development of surgical strategies such as two-stage hepatectomy or the liver-first approach in combination with preoperative chemotherapy has contributed to improved patient prognosis. The role of postrecurrence treatment including repeat hepatectomy is also significant for longer-term survival. While aggressive hepatectomy should not be abandoned for curettage, not only liver tumor number or size but also other prognostic factors such as the pathologic profile of primary disease, KRAS or BRAF gene mutation, or response to preoperative chemotherapy should be considered to judge the feasibility of surgical resection. Although the opportunity for conversion from unresectable to resectable disease is expected to increase with the development of systemic chemotherapy, pathologic complete tumor response is rarely achieved. Surgery and chemotherapy should be mutually complementary to achieve long-term survival and hopefully tumor curettage.

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