One-third of patients with colon cancer will develop metastases to the liver.
Sean P. Cleary, M.D., surgical oncologist for Mayo Clinic in Rochester, Minnesota, explains the safe and aggressive treatment options used by Mayo Clinic physicians when colorectal cancer has metastasized to the liver. Learn more about how Mayo Clinic physicians offer surgery to more patients and improve patient outcomes in treatment of liver metastases. colorectal cancer is obviously one of the most common cancers in North America. It's about the third most common fatal cancer. Unfortunately, about a third of patients with colon cancers will develop spread to the liver at some point in time of their diagnosis. It's very important that we make sure that we differentiate between benign liver lesions, which many patients have an actual metastases. So that's why the work up is important. Most patients can be diagnosed just on cT scan or MRI alone. Typical view of colorectal cancer is this is something that affected people in their sixties and seventies where seeing much more cases of colorectal cancer in younger populations, patients in their mid twenties and early thirties. But I don't think we have very firm understanding of why we're seeing advanced colorectal cancer in younger populations. There are certainly some trends that we're observing just in terms of uh people size in terms of as the population obesity rates rise, we certainly know that some of the patients with younger patients with colon cancer can have very aggressive disease. And so therefore we need to be very aggressive. In return, we've looked at new adjuvant chemotherapy prior to liver resection for metastatic colorectal cancer and a couple randomized trials. We have the epoch one study which compared full fox to placebo prior to uh liver resection, that showed a benefit in disease free and overall survival uh in patients that received chemotherapy, The results were not as dramatic as we were expecting, but I think that certainly did at least reinforced that there was a positive trend. The follow up study to that used an agent called an egg far inhibitor. Um Cytoxan mob added to the chemotherapy and unfortunately found that the addition of any G FR inhibitor to chemotherapy before liver surgery had a detrimental effect speaks to really why we need to take a very personalized approach to patients in these situations. And we need to evaluate respectability early in the disease course because it can have impact on the type of chemotherapy agents that we select, but also the duration of chemotherapy that we want to do before liver surgery. That's where I think an in depth and knowledge of liver surgery is important because while in the past we used to count lesions or look at the number and their size or we used to think that patients had to have spots on one side or liver and not the other. All of those rules have gone out the window. Now. Now we can offer surgery to patients as long as we can remove all of the lesions that we see and have an adequate liver volume after the operation for the patient to survive. So we need approximately 30% of their original liver size to be left at the end of the operation to ensure that the patient has enough liver to get safely through the postoperative period. If that's not enough, if we see patients where they don't have enough anticipated liver volume, we can modulate that we can grow that area of the liver before the operation. To make the operation safer. The ability to grow the liver before the operation has been a phenomenal advance. It's allowed us to offer surgery to so many more patients. The most common technique that we have is what we call portal vein embolization. Where we actually block off the portal vein to the areas that have the cancer in it. So the portal vein carries about two thirds of the blood supply to the liver. If we block off that vein to the affected side of the liver, we that shunts blood to the good side of the liver and encourages that part of the liver to grow. And so we can see that area. The liver increase by 50% even double given adequate time of about six weeks for that to grow after that procedure. One of the things about liver surgery is that there's a very strong volume two outcome relationship. So we know that the risk of postoperative complications and the risk of uh adverse outcomes and the chances of survival after liver surgery are directly correlated to the number of procedures that an institution does. I think at Mayo Clinic were really able to offer not only very safe but also very aggressive liver surgery. We not only have the standard of care approaches, but we also have investigative approaches in terms of not only offering surgery. Two more patients but um improving their outcomes after surgery