Chinese guidelines for the diagnosis and comprehensive treatment of hepatic metastasis of colorectal cancer

Excerpt

The liver is the most common anatomical site for hematogenous metastases of colorectal cancer (Foster 1984; Fong et al. 1997), and hepatic metastases are one of the most difficult and challenging points in the treatment of colorectal cancer. Hepatic metastases are found among 15–25% of patients suffering from colorectal cancer at the time of primary diagnosis. Another 25–35% of patients will be found after apparently curative radical excision has been performed for the primary tumor. Most of these patients (about 80–90%) will not be suitable candidates for radical excision of their hepatic metastases. Hepatic metastases are therefore the most common cause of death for colorectal cancer patients (Foster 1984; Vibert et al. 2005; Kemeny 2006; Lau and Lai 2007; Taniai et al. 2007; Arru et al. 2008). The median survival time for patients with untreated hepatic metastases is only 6.9 months, with a 5-year survival rate of 0% (Sharma et al. 2008; Elias et al. 2004). However, median survival for patients following successful radical resection of hepatic metastases is 35 months, and the 5-year survival rate for such patients is 30–50% (Van den Eynde and Hendlisz 2009; Slupski et al. 2009; De Jong et al. 2009; Giuliante et al. 2009; Shimada et al. 2009). Furthermore, a percentage of patients whose hepatic metastases cannot be resected at the time of detection can be converted to resectable using systemic chemotherapy. Thus, the multidisciplinary team (MDT), utilizing active combined modality therapy, can reduce the risk of hepatic metastases of colorectal cancer occurring, and improve the surgical resection rate for colorectal hepatic metastases, and the 5-year survival rate following surgery (Fahy et al. 2009; Timmerman et al. 2009). …