Minimally invasive treatment strategies for colorectal cancer liver metastases
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1.Department of Liver Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China;2.Department of Hepatobiliary Surgery, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei 230001, China

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R735.3

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    Abstract:

    Colorectal cancer is a common malignant tumor worldwide and a significant cause of cancer-related deaths. The liver is the most frequent site of metastasis for colorectal cancer, about 20% of patients have simultaneous liver metastasis, and an additional 20% develop liver metastasis during the progression of the disease. Colorectal cancer liver metastasis (CRLM) is currently a focal and challenging aspect of colorectal cancer treatment, and also an essential factor affecting the prognosis of patients. Surgical resection remains the optimal treatment choice for long-term survival and even cure. Minimally invasive resection, in particular, combines the advantages of minimally invasive procedures with curative effects, showing equivalent long-term oncological efficacy to open surgery. However, limited by tumor size, location distribution and other anatomical factors, liver function, and general status of patients, only a few patients are suitable for surgical resection at the time of initial diagnosis. Other minimally invasive treatment strategies include ablation therapy, stereotactic body radiation therapy, interventional therapy, etc. The development of these technologies provides new therapeutic opportunities for unresectable patients and also improves the survival rates of systemic treatment alone. Ablation therapy, for selected patients, combines the minimally invasive nature with radical effect similar to surgery, and is also more advantageous for deep-seated tumors. Stereotactic body radiation therapy is an important alternative for difficult or recurrent lesions that are unsuitable for surgical resection or ablation. Furthermore, Y90 selective internal radiation therapy has a dual effect of tumor control and enlarging the remnant liver. Its significance is continuously growing in the era of transformative treatment. With the deepening of minimally invasive concepts and technological advancements, there has been some progress in the minimally invasive treatment of CRLM. However, it still faces numerous challenges, such as how to rationally combine or sequentially use minimally invasive treatment strategies in the era of precision, personalized, and transformative therapy. When selecting minimally invasive treatment strategies, individualized evaluation and comprehensive treatment should be carried out according to the guidance of the multidisciplinary team, with the goal to achieve R0 resection or no-evidence-of-disease status as much as possible, thereby maximizing the long-term survival rates for patients. This article provides a review of recent advances in minimally invasive treatment strategies for CRLM, so as to serve as a reference for clinical practice.

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ZHANG Weizhi, LIU Lianxin. Minimally invasive treatment strategies for colorectal cancer liver metastases[J]. Chin J Gen Surg,2024,33(1):122-130.
DOI:10.7659/j. issn.1005-6947.2024.01.014

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History
  • Received:November 05,2023
  • Revised:January 04,2024
  • Adopted:
  • Online: February 05,2024
  • Published: