17TH ANNUAL SURGICAL UPDATE - RECTAL CANCER
VANCOUVER DECEMBER 2, 2000
Stephen Chung, Vancouver; John MacFarlane, Vancouver
Liver metastasis in rectal cancer is the most common cause of mortality following successful surgery. Metastases can be found at the time of initial presentation, at
subsequent follow-up, and in conjunction with local failure. These three clinical scenarios will be discussed using actual cases. Strategies for routine surveillance
for the discovery of liver metastases and imaging techniques will be discussed.
Surgical resection is the treatment of choice for selected malignant liver tumours. Appropriate utilization of radiological imaging, surgical technique and
perioperative management allows liver resections to be performed safely. Liver resections are currently indicated for the treatment of hepatocellular carcinoma and
hepatic metastases from colorectal cancer. Individualized selection criteria must be used in considering resection for other primary tumours of the liver or
metastases from sites other than the colon or rectum. The five-year survival rate of selected patients with completely resected liver metastases from colorectal
carcinoma ranges between 18 to 46%. Major factors influencing outcomes include stage of primary tumour, disease free interval, CEA level, number of tumours, and
tumour size. Contraindications to resection in general include uncontrolled primary disease, extrahepatic-metastases, more than five metastatic lesions, poor liver
function and geperal poor medical condition. Advances in many areas however, continue to expand the indications for resection in many of these patients. The role of
chemoembolization and ablation techniques such as cryotherapy, ethanol injection and radiofrequency ablation are in evolution. These modalities may be considered for
primary or adjuvant therapy in selected patients.
Bibliography
1. Fong Y, Fortner I, Sun RL, Brennan MF, Blumgart LH: Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer; analysis of 1001
consecutive cases. Ann Surg 1999; 230:309-21.
2. Fong Y, Sun RL, Iarnagin W, Blumgart LH: An analysis of 412 cases of hepatocellular carcinoma at a western center. Ann Surg 1999;239:790-800.
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