Liver Resectability in Metastatic Colorectal Cancer

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It is important to determine whether disease in the liver can be resected when assessing an individual with liver metastatic colorectal cancer (CRC), since this treatment option could result in clinical remission post-surgery, says Marwan Fakih, MD. Patients who will benefit the most from surgery are those who have an R0 resection, meaning all microscopic margins are negative. However, some patients with a positive microscopic margin may still benefit from surgery, adds Fakih.

The likelihood of disease resectability can be stratified into the following categories: clearly resectable disease, possibly resectable disease, and unresectable disease. Individuals with metastatic disease to the liver that are deemed unresectable have the option of aggressive chemotherapy that may allow them to undergo resection down the road, states Fakih.

There are known benefits in beginning chemotherapy as soon as possible for patients with bulky metastatic disease, which may be accomplished without undergoing primary tumor resection. Individuals that may be considered for primary tumor resection include those with symptomatic disease or individuals with low volume disease in the liver, yet a sizable tumor in the colon, notes Fakih.

Patients with metastatic colorectal cancer often present with an unresected primary tumor, also known as synchronous metastatic disease. There has been a lot of debate regarding whether to resect the primary tumor, and clinical trials are ongoing that will help to answer this question. There is currently no clear evidence that this would improve overall survival, says Fakih.