Current Trends on the Treatment Sequence for Colorectal Cancer with Liver Metastases

Abstract

Purpose of Review

Colorectal cancer liver metastases (CRCLM) are a significant clinical problem, with different treatment options, depending on the patient's health status and the extent of the disease. With the ideal treatment sequence between resection of the primary cancer, the hepatic metastases and chemotherapy being a matter of debate, the goal of this paper is to evaluate and analyze the current trends regarding the treatment sequence of metastatic colorectal cancer (CRC).

Recent Findings

The standard sequence of resecting the primary first, followed by chemotherapy, and then dealing with the metastatic disease has evolved over time, owing to better chemotherapy regimens and improved surgical technique. As a result, there are now the options of simultaneous resection or that of the "liver first technique" where the patient first undergoes chemotherapy, followed by hepatectomy for the metastatic lesions, and finally colectomy for the primary lesion. Advances in the locoregional management of hepatic metastases, such as radiofrequency ablation (RFA), transarterial chemoembolization (TACE), and microwave ablation, have also added significantly to the surgical armamentarium.

Summary

The key observation is that no method is ideal for every patient. It is necessary to identify the advantages and disadvantages of the different strategies, so as to find the "right" therapeutic strategy for the "right" patient.

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