Diagnostikk og behandling av colorektale levermetastaser : Hvem skal behandles og hva er behandlingsalternativene?

Abstract

Background: This paper reviews development of multidisciplinary modalities and the aggressive surgical approach that has been adopted to extend the frontiers of surgical therapy for colorectal metastases. The review is restricted to seven specific topics: 1) patient selection, 2) timing of resection of liver metastases synchronous to colorectal tumour, 3) re-resection when hepatic recurrence 4) prognostic factors for recurrence and survival after hepatectomy, 5) downstaging with neoadjuvant chemotherapy, 6) systemic adjuvant chemotherapy and 7) quality of life Methods: A PubMed, Embase and Cochrane search was performed to identify papers regarding treatment of colorectal liver metastases. Results/conclusion: All patients investigated for surgical treatment of colorectal liver metastases should undergo a spiral CT, in addition to IOUS, before resection. CT-PET or FDG-PET can be used if spiral CT is inconclusive. Biopsy should not be a part of the preoperative assessments. Patients with liver metastases synchronous to colorectal tumour should be treated with a staged resection if the patient is over 70 years old, needs an extensive hepatectomy or has a significant blodloss during the colectomy. All other patients should be treated with simultan resection. Patients with hepatic recurrence after hepatectomy, should be treated with re-resection if possible. Patients with resectable hepatic metastases should be treated with a curative hepatectomy regardless of prognostic factors. 20-45 % of non-resectable pre-selected patients, can become resectable, if downstaged with neoadjuvant chemotherapy. These patients have a significant longer survival than patients treated only with palliative chemotherapy, but a high recurrence rate. All patients should receive systemic adjuvant chemotherapy, because of a significant longer diseases-free survival. A more aggressive surgical approach does not influence on “quality-of-life”, but unnecessary laprotomy must be avoided.