Liver metastases unit
This unit is specialized in surgical treatment of tumours that mainly affect the organs of the digestive tract: colon, rectum, stomach, pancreas and others less frequent, such as cancer of the esophagus, liver, of bile ducts or neuroendocrine tumours.
Hepatic metastases are malignant lesions in the liver caused by cancer located in another organ, especially the digestive tract, the breast, the lung and the pancreas. Liver metastases are frequent in the course of the natural history of cancer since they can appear in up to 25% of patients. The main causes are those tumors that drain through the venous system such as colorectal carcinoma, which is the cause of 40% of these metastases.
The incidence of colorectal cancer in the world is approximately 1,400,000 new cases per year. Of these, 50 to 70% will have liver metastases at some point during their illness and are usually the cause of death.
- Between 15 and 25% of patients will have a liver metastasis at the same time when the primary tumor is diagnosed (synchronously)
- Up to 50% of patients will develop it in the course of the disease (metachronously).
The treatment and prognosis of these lesions is very different depending on the origin of the primary tumor.
Years ago, the chances of obtaining cure or an increase in survival for patients with liver metastases were scarce and only a few patients could be treated, going through surgery to resect the metastases. Numerous studies have shown that resection of metastases is the most important prognostic factor for patient survival. Therefore, the goal of treatment is to achieve complete resection of liver metastases, the only curative option.
In that sense, all recent advances in this field are aimed to achieve its elimination through surgical intervention. These advances such as new and very innovative surgical techniques, new types of chemotherapy and new diagnostic methods help assess the remaining liver function (in case a large resection of the liver is necessary), essential to perform the surgery, and have greatly expanded the indications for resectability surgery by changing the definition of a non-operable patient, that is, making patients that were not operable in the past eligible. Through this, prolonged survival can be achieved (70% survival at 5 years in some patients), and even cure in some cases always within a multidisciplinary management and by a team with high experience.
First, the development of new chemotherapies with or without target therapies allows the reduction of lesions and makes resection of lesions previously considered unresectable possible. Recent studies show that this approach achieves up to 87% of subsequent complete resection of metastases. Likewise, the new imaging techniques and evaluation of liver function make it possible to define better strategies for the management of metastases (for example, mebrophenin scintigraphy). Finally, advances in surgical techniques have been key to the treatment of liver metastases.
In surgical treatment there are several possibilities, but in general the surgery is aimed at the complete resection of the lesions. There are different surgical strategies when considering liver surgery depending on the characteristics of the metastases and the patient.
The treatment of each patient must be selected individually and by a multidisciplinary expert team since this will be based not only on the origin of the primary tumor but also on the resectability of the metastases, on the physical condition of the patient, as well as on the tumor biology, to, as previously stated, achieve its resectability. Therefore, the decision is made by a multidisciplinary team expert in the management of liver metastases, consisting of liver surgeons, oncologists, radiologists, pathologists, anesthetists, nurses, etc. This approach has proven to be very beneficial for patient survival and is also key to being able to offer the best treatment option.
Surgery can be performed simultaneously, at the same time as colon resection in some cases. The surgery can also be performed in two stages if the necessary liver resection is expected to be extensive and thus reduce the morbidity of the patient. Finally, in those patients in whom the tumor of the colon is asymptomatic, liver surgery may be considered first after intravenous chemotherapy and in a second time perform primary tumor surgery.
Radiofrequency ablation is a relatively simple technique for the destruction of metastases by heat and can be used as complementary to the surgery either in case of recurrence of liver lesions or for patients to whom the surgery is not indicated.
Intraarterial therapies, intraarterial liver chemotherapy, are currently used to alleviate symptoms and prolong survival in those patients who present liver metastases for whom the surgery is not indicative or in those who are refractory to chemotherapy. Selective infusion with chemotherapeutic agents or embolizers increases the arrival of these agents in liver tumors, decreasing their effect on the healthy liver and therefore reducing toxic systemic effects.
Clinical excellence of Quénet Torrent Institute
Quénet Torrent Institute has surgeons specialized in the treatment of these liver lesions providing the most innovative techniques:
- Portal venous embolization
- Radiofrequency ablation combined with partial hepatectomy
- 2-stage hepatectomy
- ALPPS technique (Associating liver partition and portal vein ligation for staged hepatectomy)
These techniques have allowed surgery in patients previously considered non eligible, and have shown a clear benefit in the survival of these patients. All this, associated with a modern technology (hybrid operating room, intraoperative ultrasound, mebrophenin scintigraphy, etc.) for the optimization of the results.
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