The document discusses guidelines for resection of liver metastases from colorectal cancer. It states that the aim of liver resection is to remove all visible cancer while leaving enough healthy liver tissue. Patients with solitary, multiple, or scattered tumors may be candidates for resection if the primary colorectal cancer has been treated. The surgeon should ensure clear margins and leave a minimum of one third of the standard liver volume to minimize risk of liver failure. Overall survival rates are improved with resection compared to chemotherapy alone.

1. Gian Luca Grazi
Hepato-Biliary-Pancreatic Surgery
National Cancer Institute Regina Elena
Rome
Liver Metastases from ColoRectal Cancer

2. Liver Metastases from ColoRectal Cancer
• The aim of liver resection (resectability) is to remove all macroscopic disease
with clear (negative) margins and leave sufficient functioning liver.
(Category of evidence II; strength of recommendation B)
• Patients with solitary, multiple, and bilobar disease who have had radical
treatment of the primary colorectal cancer are candidates for liver resection.
(Category of evidence III; strength of recommendation C)
• The ability to achieve clear margins (R0 resection) should be determined by
the radiologist and surgeon in the regional hepatobiliary unit.
(Category of evidence III; strength of recommendation C)
• The surgeon should define the acceptable residual functioning volume,
approximately one third of the standard liver volume, or the equivalent of
a minimum of two segments.
(Category of evidence III; strength of recommendation C)
Guidelines for resection of colorectal cancer liver metastases
Garden OJ, Gut 2006;55 (Suppl III): iii1–iii8

3. Liver Metastases from ColoRectal Cancer
Chemotherapy and cure
85 (5%) 5 years survivors
26 (1%) NED without surgery Cure < 1%
Sanoff HK, J Clin Oncol 2008, 26:5721-5727

4. Liver Metastases from ColoRectal Cancer
Cucchetti A, Ann Surg Oncol 2014, epub

5. Liver Metastases from ColoRectal Cancer
Cucchetti A, Ann Surg Oncol 2014, epub

6. Liver Metastases from ColoRectal Cancer
Jones RP, Br J Surg 2012; 99: 1263–1269

7. Liver Metastases from ColoRectal Cancer
• 200 Medical Oncologists with > 5
years of practice
(overall 80% response rate)
• CT scans reviewed by 3 hepatic
surgeons who conducted more than
50 hepatectomies and currently
performing CRLM surgery as a major
component of their practice, defined
resectability

8. Liver Metastases from ColoRectal Cancer
HCC
131
Intrahepatic
Cholangiocarcinoma
45
Metastases
259
Perihilar
Cholangiocarcinoma
26
Others
70
551 Liver Resections
(June 2010 – April 2017)
Gallbladder
20

9. Liver Metastases from ColoRectal Cancer
Overall Survival after Liver Resections for Colo Rectal Metastases

10. Liver Metastases from ColoRectal Cancer
Overall Survival after Liver Resections for Colo Rectal Metastases
by Tumor Diameter

11. Liver Metastases from ColoRectal Cancer

12. Liver Metastases from ColoRectal Cancer

13. Liver Metastases from ColoRectal Cancer

14. Liver Metastases from ColoRectal Cancer

15. Liver Metastases from ColoRectal Cancer

16. Liver Metastases from ColoRectal Cancer

17. Liver Metastases from ColoRectal Cancer

18. Gian Luca Grazi
Hepato Biliary Pancreatic Surgery
National Cancer Institute “Regina Elena”, Rome, Italy
gianluca.grazi@ifo.gov.it
www.chirurgiadelfegato.it
Liver Metastases from ColoRectal Cancer