Colorectal Liver Metastases: Current Management and Future Perspectives
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World Journal of W J C O Clinical Oncology Submit a Manuscript: https://www.f6publishing.com World J Clin Oncol 2020 October 24; 11(10): 761-808 DOI: 10.5306/wjco.v11.i10.761 ISSN 2218-4333 (online) REVIEW Colorectal liver metastases: Current management and future perspectives Jack Martin, Angelica Petrillo, Elizabeth C Smyth, Nadeem Shaida, Samir Khwaja, HK Cheow, Adam Duckworth, Paula Heister, Raaj Praseedom, Asif Jah, Anita Balakrishnan, Simon Harper, Siong Liau, Vasilis Kosmoliaptsis, Emmanuel Huguet ORCID number: Jack Martin 0000- Jack Martin, Raaj Praseedom, Asif Jah, Anita Balakrishnan, Simon Harper, Siong Liau, Vasilis 0001-9545-0298; Angelica Petrillo Kosmoliaptsis, Emmanuel Huguet, Department of Surgery, Addenbrookes Hospital, NIHR 0000-0001-5489-5733; Elizabeth C Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge Smyth 0000-0002-4667-1817; Nadeem University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom Shaida 0000-0002-6843-7458; Samir Khwaja 0000-0002-2481-6800; HK Angelica Petrillo, Department of Precision Medicine, Division of Medical Oncology, University Cheow 0000-0002-2334-3597; Adam of Campania "L. Vanvitelli", Napoli 80131, Italy, & Medical Oncology Unit, Ospedale del Duckworth 0000-00028664-4987; Mare, 80147 Napoli Italy Paula Heister 0000-0001-7207-869X; Raaj Praseedom 0000-0001-9541- Elizabeth C Smyth, Department of Oncology, Addenbrookes Hospital, NIHR Comprehensive 6356; Asif Jah 0000-0001-5541-1550; Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals Anita Balakrishnan 0000-0001-6406- NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom 6066; Simon Harper 0000-0001-6016- 8049; Siong Liau 0000-0001-5155- Nadeem Shaida, Samir Khwaja, Department of Radiology, Addenbrookes Hospital, NIHR 4300; Vasilis Kosmoliaptsis 0000- Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge 0001-7298-1387; Emmanuel Huguet 0000-0001-5816-5308. University Hospitals NHS Foundation Trust, Cambridge CB22 0QQ, United Kingdom Author contributions: Martin J HK Cheow, Department of Nuclear Medicine, Addenbrookes Hospital, NIHR Comprehensive designed the structure of the Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals overall manuscript and authored NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom text in all sections; Petrillo A and Adam Duckworth, Paula Heister, Department of Pathology, Addenbrookes Hospital, NIHR Smyth EC authored text in the Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge chemotherapy sections; Shaida N University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom authored text in the interventional radiology sections; Khwaja S Corresponding author: Emmanuel Huguet, BSc, DPhil, FRCS, MBChB, Surgeon, Surgical authored text in imaging sections; Oncologist, University Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Cheow H authored text in the Biomedical Research and Academic Health Sciences Center, Cambridge University Hospitals nuclear medicine section; NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom. Duckworth A and Heister P [email protected] authored text in the pathology section; Praseedom R, Jah A, Balakrishnan A, Harper S, Liau S Abstract and Kosmoliaptsis V authored text The liver is the commonest site of metastatic disease for patients with colorectal in the surgery sections; Huguet E cancer, with at least 25% developing colorectal liver metastases (CRLM) during designed the structure of the the course of their illness. The management of CRLM has evolved into a complex overall manuscript and authored field requiring input from experienced members of a multi-disciplinary team text in all sections. All authors WJCO https://www.wjgnet.com 761 October 24, 2020 Volume 11 Issue 10 Martin J et al. Colorectal liver metastase have read and approved the final involving radiology (cross sectional, nuclear medicine and interventional), manuscript. Oncology, Liver surgery, Colorectal surgery, and Histopathology. Patient management is based on assessment of sophisticated clinical, radiological and Conflict-of-interest statement: All biomarker information. Despite incomplete evidence in this very heterogeneous other authors have nothing to patient group, maximising resection of CRLM using all available techniques disclose. remains a key objective and provides the best chance of long-term survival and cure. To this end, liver resection is maximised by the use of downsizing Open-Access: This article is an chemotherapy, optimisation of liver remnant by portal vein embolization, open-access article that was associating liver partition and portal vein ligation for staged hepatectomy, and selected by an in-house editor and combining resection with ablation, in the context of improvements in the fully peer-reviewed by external functional assessment of the future remnant liver. Liver resection may safely be reviewers. It is distributed in carried out laparoscopically or open, and synchronously with, or before, accordance with the Creative colorectal surgery in selected patients. For unresectable patients, treatment Commons Attribution options including systemic chemotherapy, targeted biological agents, intra- NonCommercial (CC BY-NC 4.0) arterial infusion or bead delivered chemotherapy, tumour ablation, stereotactic license, which permits others to radiotherapy, and selective internal radiotherapy contribute to improve survival distribute, remix, adapt, build and may convert initially unresectable patients to operability. Currently evolving upon this work non-commercially, areas include biomarker characterisation of tumours, the development of novel and license their derivative works systemic agents targeting specific oncogenic pathways, and the potential re- on different terms, provided the emergence of radical surgical options such as liver transplantation. original work is properly cited and the use is non-commercial. See: htt Key Words: Colorectal; Cancer; Liver; Metastases; Management; Review p://creativecommons.org/licenses /by-nc/4.0/ ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. Manuscript source: Invited manuscript Core Tip: The management of colorectal liver metastases is a complex evolving field requiring input from an experienced multi-disciplinary team involving radiology (cross Received: February 27, 2020 sectional, nuclear medicine and interventional), Oncology, Liver surgery, Colorectal Peer-review started: February 27, surgery, and Histopathology. Patient management is based on clinical, radiological and 2020 biomarker information. Despite incomplete evidence in this very heterogeneous patient First decision: April 7, 2020 group, maximising resection of colorectal liver metastases using all available techniques Revised: May 14, 2020 remains a key objective and provides the best chance of long-term survival. For Accepted: August 31, 2020 unresectable patients, optimal systemic and locoregional chemotherapeutic, biological and Article in press: August 31, 2020 radiotherapeutic treatments improve survival, and may convert initially unresectable Published online: October 24, 2020 patients to operability. P-Reviewer: Fan H, Mikulic D, Romani A Citation: Martin J, Petrillo A, Smyth EC, Shaida N, Khwaja S, Cheow H, Duckworth A, Heister S-Editor: Zhang L P, Praseedom R, Jah A, Balakrishnan A, Harper S, Liau S, Kosmoliaptsis V, Huguet E. Colorectal liver metastases: Current management and future perspectives. World J Clin Oncol L-Editor: A 2020; 11(10): 761-808 P-Editor: Li JH URL: https://www.wjgnet.com/2218-4333/full/v11/i10/761.htm DOI: https://dx.doi.org/10.5306/wjco.v11.i10.761 INTRODUCTION Colorectal cancer (CRC) represents a major worldwide health care burden, as the second most common cancer diagnosed in women and third most common in men, and accounting for 10% of all annually diagnosed cancers and cancer-related deaths worldwide[1]. As result of improvements in detection through screening[2], better referral pathways[3], centralisation of services[4], effective primary surgery[5], development of systemic chemotherapy[6], biological agents[7], and understanding of tumour biology[8], survival rates following diagnosis have improved[9]. Nevertheless, at least 25%-50% of patients with CRC develop colorectal liver metastases (CRLM) during the course of their illness. From a historical perspective, the surgical management approach to CRLM has undergone a significant evolution. Starting from an era prior to the 1930s during which liver surgery for malignancy presented insurmountable challenges for technical and oncological reasons, tentative attempts at liver resection for malignancy were WJCO https://www.wjgnet.com 762 October 24, 2020 Volume 11 Issue 10 Martin J et al. Colorectal liver metastase made in the subsequent decades resulting in early reports establishing proof of principle that long term survival following resection of CRLM was possible[10,11]. These results were confirmed and emphasised by larger landmark studies firmly establishing liver surgery as a potentially curative treatment for CRLM[12,13]. The era since has been characterised by progress in understanding of tumour biology as well as surgical and oncological developments. These overlapping and interdependent factors have directed the modern management of CRLM to a multidisciplinary approach involving radiology (cross sectional, nuclear