New strategies for advanced colorectal liver metastases: no more a fatality

Abstract

Colorectal cancer constitutes one of the most frequent types of cancer worldwide with 50% of patients developing metastases to the liver. Surgical treatment of colorectal liver metastases currently is the only treatment option able to provide long-term survival. However, only 20% of patients is suitable for surgery at the time of diagnosis. In the remaining 80% of patients, advanced metastatic disease prevents a complete resection of all tumors while leaving sufficient liver tissue. These patients normally have a very poor outcome. Different treatment strategies have developed in recent years to increase the proportion of patients that is suitable for surgical treatment. New types of chemotherapy are able to induce significant tumor shrinkage leading to a situation that enables safe liver surgery. Also, specific surgical techniques can induce growth of liver tissue. By this way, complete surgical resection of all tumors may become possible while leaving a sufficient amount of normal liver tissue. The research described in this thesis shows that with these new treatment strategies long-term survival can be achieved for an increasing number of patients with advanced colorectal liver metastases. Multidisciplinary treatment in a specialized center by experienced liver surgeons, oncologists and radiologists remains essential in the achievement of such results