Survival improves for colon cancer liver metastases
Ronald F. Wolf, M.D.
Surgical oncologist, pancreas and liver surgery
Providence Cancer Center and The Oregon Clinic
Published May 2013
Of the 150,000 Americans who develop colon and rectal cancer each year, about half will develop liver metastases. This progression to stage IV colon cancer was once a dismal prognosis, with a median survival of six months to a year.
While this is always an unwelcome occurrence, advancements in liver surgery, ablative techniques, interventional radiology and chemotherapy have transformed survival expectations dramatically.
Take the case of one of our patients, a 30-year-old who presented with a large abdominal mass while pregnant. Biopsies confirmed a colorectal liver metastasis, shown in this scan.
At first it appeared the patient had unresectable disease because there wouldn’t be enough liver left after removing the cancer. But the patient’s excellent response to a short course of chemotherapy allowed us to proceed with a staged liver ablation (partial left-lobe and colon resection). This was followed by a portal vein embolization to expand the future liver remnant. Six weeks later the patient had an extended right-lobe liver resection and is now disease free two years from diagnosis.
Advances in liver surgery
Today major liver resections frequently are performed laparoscopically, which has reduced the morbidity and mortality risk profile to that of colon or rectal primary tumor resection.
Our own data prove the value of this approach. Of the patients undergoing major liver resection, only 18 percent needed a blood transfusion, and just 10 percent required a stay in the intensive care unit. Most importantly, the perioperative mortality rate was 1 to 2 percent.
New tumor ablation technologies allow for safe laparoscopic destruction of tumors with minimal risk and rapid recovery.
Although there are no limitations to the size or number of tumors that can be treated surgically, candidates must have at least 20 percent of normal liver volume. Further, extrahepatic metastatic disease, including lung and peritoneal implants, must be resectable.
Patients diagnosed with colorectal liver metastases should be referred to a hepatobiliary/pancreatic surgeon. Surgery is typically the first line of treatment for limited tumors smaller than 2 centimeters. Most patients with larger tumors receive neoadjuvant chemotherapy.
These new techniques are improving survival for patients with colorectal liver metastases, including those once thought to be beyond surgical intervention. Today half of these patients will survive five years, and 27 percent will be alive 10 years after their diagnosis.