演題抄録

臓器別シンポジウム

開催概要
開催回
第55回・2017年・横浜
 

Modern Management of Colorectal Liver Metastases (CLM) : The need of a multidisciplinary approach

演題番号 : OSY1-4

[筆頭演者]
René Adam:1 

1:PAUL BROUSSE HOSPITAL・HEPATOBILIARY CENTER

 

Liver metastases affect around 50% of patients with colorectal cancer.
Surgical resection is the gold standard treatment for metastases since the only one that could provide long-term survival.The optimal results from surgery are obtained for 3 or fewer metastases, unilobar,without extra-hepatic disease and clear surgical margins.However, none of these factors is currently an absolute contraindication to surgery, provided that the overall strategy is potentially curative.In recent years results of surgery have improved both for the diminution of the perioperative mortality and for the expected rate of 5-year survival (42% in the international registry LiverMetsurvey).
However, most patients with hepatic metastases present initially with unresectable disease.Systemic chemotherapy is the common treatment with recently, a dramatic improvement in both rates of response and survival, using targeted therapies.However, the increase in median survival still little impacts long-term survival in the absence of surgery.Therefore, strategies include conversion chemotherapy for downsizing the metastases and making them suitable for resection with a 5-year survival of 30-35% at 5 years.To further increase the resectability rate, specific techniques such as portal embolisation, radiofrequency ablation combined with resection, and two-stage hepatectomies including ALPPS are presently available.Overall the onco-surgical concept to combine chemotherapy and surgery is increasingly accepted as the best mean to improve the outcome.In patients who relapse following an hepatectomy, repeat resections can give the same survival benefit,with a risk of operative mortality as low as that of the first liver resection.
In summary, while merely palliative in the past, the treatment of CLM is currently aiming to long-term remission.Strategies are becoming more « agressive » and multidisciplinary, resulting in a significant gain in survival of many patients promised in the past,to a very poor outcome.

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