Modern Management of Colorectal Liver Metastases

Today we will be discussing the modern management of colorectal liver metastases. For today’s episode, we are excited to be welcoming on Dr. Yuman Fong, Sangiacomo Family Chair in Surgical Oncology and Surgical chair at City of Hope Cancer Center in California. Dr. Fong previously held the Murray F. Brennan Chair of Surgery at Memorial Sloan Kettering Cancer center, and is an international expert in both liver and pancreatic surgery.

Background Reading:

NCCN Guidelines: Colon Cancer

NCCN guidelines for colon cancer, which includes the management strategy for patients with liver metastases.

Sabiston Textbook of Surgery, Twentieth Edition

Overview of the surgical management of the liver and hepatic neoplasms, including metastatic colorectal cancer.

Articles Discussed:

Patient selection for the surgical treatment of resectable colorectal liver metastases.

Araujo RL, Riechelmann RP, Fong Y

2017 review article in The Journal of Surgical Oncology, outlining the surgical and medical management of colorectal liver metastases. Figure depicting the utilization of the colorectal liver metastasis clinical risk score in order to guide chemotherapy and surgical strategy.

Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.

Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH

Classic article depicting a clinical risk score that predicts survival in patients with resected colorectal liver metastasis. 5 preoperative factors, with each factor contributing to 1 point on the score, with more points = worse prognosis. At time of initial publication in 1998: 5 pts led to 14% 5 year survival vs. 60% for someone with 0 points. The 5 factors are: >1 liver metastasis, node positive primary, <12 months between primary colorectal tumor and liver met, >5cm liver tumor, preop CEA >200. 

Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1,600 patients during two decades at a single institution.

House MG, Ito H, Gönen M, Fong Y, Allen PJ, DeMatteo RP, Brennan MF, Blumgart LH, Jarnagin WR, D’Angelica MI

Data from Memorial Sloan Kettering that compared survival after resection for colorectal liver metastases for patients during 2 different eras: 1985-1998, and 1999-2004. Many of the patients in the more modern era were offered therapy with oxaliplatin or irinotecan, which likely led to the improved survival in these patients. Recurrence free survival in both generations were similar, suggesting that chemotherapy regimens and possibly patient selection differences led to differences in overall survival.