As such, liver directed therapies shift the cause of death to other sites at a later time point. By comparison, those who are resected but recur have a median survival of 40 months, and have a 17% 5-year survival.
Currently, patients who do not undergo surgical treatment of liver metastases typically live less than 18 months, with no 5-year survivors. Thus, addressing liver metastases initially is the most clinically relevant, since this is the most life limiting. Disease specific survival is also significantly shorter for those who die of liver metastasis, compared to patients who die from other metastatic sites. Of patients who succumb to the disease, 49% will have liver dominant disease, and 83% will have some liver involvement. Another 20–25% will later develop liver metastases.
Best available evidence for treatment strategies will be presented as well as potential new directions.Īt presentation, 20–25% of patients will have distant metastases, most to the liver. This is followed by a discussion of surgical and ablative treatments of other sites of disease including lung, peritoneum, bone, lymph nodes and brain. We then will address key issues with metastatic colorectal cancer to the liver and available treatments. In this review, we will first summarize the natural history of colorectal cancer metastases. Thus, management of liver metastases has made enough progress so that other sites of metastases have become more clinically relevant. Consequently, other sites of metastases are not only more likely to become apparent, but also more likely to cause symptoms and influence survival. The median survival of patients after hepatectomy for stage IV metastatic colorectal cancer in the liver is over forty months. In patients treated by hepatectomy, approximately 30% ultimately die of liver metastases. The fact that liver resection is affecting outcome is also highlighted by the fact that over 70% of patients with unresectable liver metastases die of their liver metastases. It is increasingly accepted and is effective at palliating symptoms, prolongs life, and can be potentially curative. In the last three decades, treatment of extrahepatic metastases by surgical and ablative procedures has proven to be effective. Even with the best chemotherapy, median survival of unresectable disease is 13–18 months.
When untreated, patients with liver metastases have a median survival of 6–9 months. Nearly one-half of patients diagnosed with colorectal cancer will be found to have liver metastases at some point during their disease. The liver is the most frequent site of metastases and dominates the length of survival for this disease. Most commonly this occurs by five means: direct extension, lymphatic spread, portal venous spread to liver, peritoneal dissemination, and vascular spread to distant organs including lung, bone, and brain.
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