Abstract and Introduction
Abstract
Background and Objective: The liver is the main site of metastatic disease, and cancer metastases remain the main limit to successfully managing the malignant disease. Liver resection (LR) for the treatment of metastatic cancer has been described for over a hundred years and is widely accepted. The role of surgery in managing non-colorectal non-neuroendocrine liver metastasis (NCNNLM), evidence is still lacking due to different factors: the paucity of cases, the wide variety of histological subtypes of the primary disease and its biological behavior, and the absence of prospective studies.
Methods: We performed a narrative review of peer-reviewed articles related to the surgical outcomes of NCNNLM. The aim of this review is determining the utility of surgery in NCNNLM, with attention to minimal invasive LRs. We analyzed the role of LR for NCNNLM according to the different cancers: digestive and non digestive.
Key Content and Findings: NCNNLM encompass a huge spectrum of histologic appearances. LR for limited NCNNLM may offer a curative option, but liver recurrence occurs frequently. Our ability to significantly predict the outcome is poor.
Conclusions: The cytotoxic chemotherapy and biologic agents have significantly altered the surgical treatment of LM. The latter treatments can convert inoperable patients into operable ones, with a clear relationship between the degree of resectability in patients judged inoperable at referral and the rate of response to the treatment scheme.
Introduction
Malignant tumors are likely to spread, leading to the development of metastases. After the lymph nodes, the liver can be considered the most common site of metastatic spread of abdominal tumors. Liver resection (LR) for metastatic cancer has been reported for over a century and is widely accepted. In addition, technical advances, technological innovation, and patient selection have remarkably improved the safety of liver surgery and let push the boundaries with extensive LR becoming more feasible.[1] To date, LR is considered the gold standard for the treatment of patients with colorectal metastases limited to the liver, achieving 5- and 10-year survival rates of up to 60% and 20%, respectively.[2] The liver is the main site of metastatic disease, and cancer metastases remain the main limit to successfully managing the malignant disease. The most common cancer that metastasizes to the liver is colorectal cancer due to the rich portal and arterial blood supply and abdominal lymphatic channels. To date, the 5-year survival after surgery for colorectal liver metastases (LM) has been variously reported as 40–58%.[3] Management of neuroendocrine LM is challenging, but LR is widely accepted, and there is sufficient evidence of its effectiveness. Concerning the role of surgery in managing non-colorectal non-neuroendocrine liver metastasis (NCNNLM), evidence is still lacking due to different factors: the paucity of cases, the wide variety of histological subtypes of the primary disease and its biological behavior, and the absence of prospective studies.[4] Thanks to improvement in surgical and anesthetics techniques, the interest in liver surgery in NCNNLM has gained attention. We present the following article in accordance with the Narrative Review reporting checklist (available at https://cco.amegroups.com/article/view/10.21037/cco-22-13/rc).
Chin Clin Oncol. 2022;11(4):28 © 2022 AME Publishing Company
