Dr. Jarnagin on the Improvements in Surgery for Patients With mCRC

William R. Jarnagin, MD, FACS, chief, Hepatopancreatobiliary Service, Benno C. Schmidt Chair, Surgical Oncology, Memorial Sloan Kettering Cancer Center, discusses the progression of surgery in treating patients with metastatic colorectal cancer (mCRC).

The surgical operations for patients with mCRC have become much safer, Jarnagin says. Surgeons tend to do fewer large resections and consequently remove less normal liver than they used to. Neoadjuvant approaches such as portal vein embolization of the liver is done more commonly to increase the safety of the operation. This procedure in particular increases the amount of functional liver left behind post-surgery.

A large number of segmental type resections are also done which allows surgeons to take patients into the operating room who have more advanced disease and an increasing number of tumors. In doing so, they can more effectively remove all of the disease.

The effectiveness of chemotherapy has also changed surgical approaches. More patients are receiving chemotherapy before surgery, and though patients have improved responses, subsequent regeneration of the future liver remnant may be compromised, he concludes.