: Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients with these tumors.
: In this module, was contextualized the clinical situations and parameterized epidemiological data and results of the various treatment modalities established.
Was realized deep discussion on detecting and staging metastatic colorectal cancer, as well as employment of imaging methods in the evaluation of response to instituted systemic therapy.
: The next step was based on the definition of which patients would have their metastases considered resectable and how to expand the amount of patients elegible for modalities with curative intent.
: Were presented clinical, pathological and molecular prognostic factors, validated to be taken into account in clinical practice.
: Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients.
: In the second module of this consensus, management of resectable liver metastases was discussed.
: Concept of synchronous and metachronous metastases was determined, and both scenarius were discussed separately according its prognostic and therapeutic peculiarities.
: Special attention was given to the missing metastases due to systemic preoperative treatment response, with emphasis in strategies to avoid its reccurrence and how to manage disappeared lesions.
: Were presented validated ressectional strategies, to be taken into account in clinical practice.
Colorectal adenocarcinoma is a common malignancy around the world and synchronous or metachronous liver metastases will be observed in about 50% of these patients. Hepatic resection is a potentially curative treatment for metastases from colorectal cancer1,2. However, only about 20% of the patients are suitable for resection, and recurrence occur in the majority of these patients and they are candidates for palliative chemotherapy. Liver transplant has been performed for liver tumors in well selected patients, mainly hepatocellular carcinoma, liver metastases from neuroendocrine tumors and peri-hilar cholangiocarcinoma emerging the concept of transplant oncology. Complete surgical resection is the treatment of choice for patients with liver metastases, but in a large proportion it is not possible to obtain a complete R0 resection. In 2006 the Oslo group started the first trial on liver transplant for patients with colorectal liver metastases (SECA I study). The inclusion criteria were R0 primary colorectal resection, unresectable liver metastases, no extrahepatic disease, at least six weeks of chemotherapy and an Eastern Cooperative Oncology Group (ECOG) performance status 0-12,3. Twenty-one patients with unresectable colorectal liver metastases (u-CRLM) were included. The overall survival rate at five years was 60% with a median survival time of 27 months. Notwithstanding the disease free survival rate was 35% at one year and all patients got relapse if observed up to three years, mainly in the form of lung metastases which were slow growing and most often resectable. Some factors were identified as related to worse prognosis (the Oslo Criteria) and include: 1) time from primary cancer surgery <2 years; 2) progressive disease on chemotherapy; 3) maximum tumor diameter >5.5 cm; and 4) CEA levels >80 μg/l. Beside Norway, liver transplant for colorectal liver metastasis have been performed in Japan, France, Canada, Portugal, Turkey, and Germany2,4,5. Very recently the Oslo group reported the preliminary results of SECA II trial, indicating that a five year overall survival of about 80% may be obtained if stricter selection criteria for liver transplant in this patient cohort are used6. Nowadays, the majority of liver transplant reported for u-CRLM utilize deceased donor liver transplant (DDLT). In Brazil DDLT is not possible due to organ shortage problem and living donor liver transplant (LDLT) seems to be the only available alternative.
Desenvolvido por Surya MKT