Oncosurgical Strategies for Unresectable Liver Metastases

摘要: Negative prognostic factors for survival have been previously used to exclude patients from hepatic resection. For with colorectal metastases, these included high number and large size of the presence extrahepatic disease [4, 5]. The same considerations made regarding width resection margin Empirically, a 1 cm or more was as one important selection criteria metastases. Regardless fact that extensive tumor involvement is associated unfavorable outcome, long-term can be achieved in when complete performed both intrahepatic deposits. In addition, it has shown tumor-free importance than its [6]. The improved knowledge influence established impact on outcome resulted pragmatic definition unresectability. current practice, liver remnant too small relation extent needed achieve radicality only remaining indicator Patients are considered resectable long all metastases completely resected margins, while leaving at least 25–30% volume prevent postoperative insufficiency [7]. general, margins >1 recommended, but should not limit macroscopically complete. Additionally, no longer contraindication surgery. main causes responsible technical unresectability therefore multinodularity, vascular-ill location disease. In divided into three categories: 1. Easily resectable. this group, adequate oncological normal parenchyma. need exists improve resectability before proceeding surgery. 2. Marginally These present disease, limiting possibilities upfront Surgery may limited by difficulties achieving due involvement. Furthermore, major hepatectomy might endanger required 25–30%. Finally, concomitant also ascribed group. Different methods reduce load “curativity” resection. 3. Definitely unresectable. This group represents subset widespread usually disseminated over multiple metastatic sites. most cases, chemotherapy treatment intraoperative strategies mandatory control downsize technically enable curative surgery patients. Obviously, chance further decreases 3. However, owing increasing efficacy chemotherapy, some will switched complex and/or sequential surgery, even presenting initially “definitely”