Changing prognosis of metastastic disease by multimodal strategy - Patients do benefit from close interactions between treating disciplines

摘要

Systemic chemotherapy has changed the prognosis of patients with metastastic disease arising from colorectal cancer. The aim of the treatment is palliation, but these patients live longer and have an acceptable quality of rife. Patients and oncologists now have an increased willingness to use more aggressive ablative treatments to get a partial or complete remission of the disease, leading to longer life expectancy. This is possible today because of improvements in surgical techniques, anesthesia, and intensive care. Even extended resections can be performed with low perioperative risk of mortality. That this treatment paradigm works has been demonstrated for colorectal liver metastases. Currently, the most important issue is not the number or site of the metastases but the adequacy of the remnant liver after complete tumor resection. Portal embolization, "two-stage" resections, and local ablative radiofrequency or microwave procedures extend the ability to treat and are now part of the routine arsenal of hepatobiliary surgeons.