Up ] Abdominal incisions ] Groin hernias ] Other hernias ] Peritonitis ] Appendicitis ] Ovarian cysts ] Oesophageal perforation ] Perforated peptic ulcer ] Diverticular disease ] Upper GI haemorrhage ] Lower GI haemorrhage ] Small bowel obstruction ] Large bowel obstruction ] Sigmoid and caecal volvulus ] Pseudo-obstruction ] Enterocutaneous fistulae ] Mesenteric ischaemia ] Acute pancreatitis ] Pyogenic liver abscess ] Amoebic liver abscess ] Hydatid disease ] Gynecological pain ] GORD ] Achalasia ] Oesophageal carcinoma ] Peptic ulcer disease ] Gastric carcinoma ] Hepatocellular carcinoma ] Pancreatic cancer ] Chronic pancreatitis ] Colonic polyps ] Colorectal carcinoma ] [ Liver metastases ] Anal carcinoma ] Inflammatory bowel disease ] Anal fissure ] Haemorrhoids ] Perianal sepsis ] Pilonidal sinus ] Rectal prolapse ] Jaundice ] Gall stones ] Portal hypertension ] Ascites ] Stomas ] Abdominal pain ] Abdominal masses ]

Liver metastases

  • 50% patients with colorectal cancer develop liver metastases
  • 20% have metastases at time of initial surgery
  • 25% develop metastases within 5 years of a 'curative' resection
  • Median survival with metastases is about one year

Gross pathological appearance of a liver metastasis

Detection of metastases

  • Value of intensive follow-up after curatiev resection for colorectal cancer is controversial
  • Ultrasound will detect lesion more than 0.5 cm in diameter
  • CT allows assessment of resectability
  • Intra-operative ultrasound superior to extra-corporeal scanning
  • Elevated tumour marker - CEA, CA 19.9, CA 242

Liver resection for metastatic disease

  • Resectional surgery is only chance of cure for patients with liver metastases
  • Only 10% of patients with metastases suitable for 'curative' hepatic resection
  • Aim is to resect tumour with more than 1 cm margin by segmentectomy, lobectomy or hepatectomy
  • 5 year survival 35% and 10 year survival 20%

Relative indications for surgical resection

  • Single lobe involvement
  • Less than three lesions without evidence of satellite lesions
  • No invasion of inferior vena cava
  • More than 20% of liver can be spared

Relative contra-indications for surgical resection

  • Hilar and coeliac nodal involvement
  • Distant metastases
  • Poor cardiovascular reserve
  • Pre-operative portal vein embolisation - atrophy of segments to be excised
  • Neoadjuvant chemotherapy

Palliation of liver metastases

  • Cryotherapy
  • Hepatic artery infusion therapy
  • Laser photo-coagulation

Bibliography

Cromheecke M,  de Jong K P,  Hoekstra H J.   Current treatment for colorectal cancer metastatic to the liver.  Eur J Surg Oncol 1999;  25:  451-463.

Heriot A G,  Karanjia N D.  A review of techniques for liver resection.  Ann R Coll Surg Eng 2002;  84:  371-380.

Huang J,  Thomas P A.  Surgical management of liver metastases from colorectal cancer.  Hosp Med 1998;  59:  608-611.

Renehan A G,  Egger M,  Saunders M P,  O'Dwyer S T.  Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials.  Br J Med 2002;  324:  1-8.

 

 
 

Copyright 1997- 2013 Surgical-tutor.org.uk