Role of the Multidisciplinary Team and Parenchyma Sparing Hepatectomy in a Patient Presenting with Complex Synchronous Metastatic Colorectal Cancer

Case Report

Austin Surg Case Rep. 2016; 1(2): 1012.

Role of the Multidisciplinary Team and Parenchyma Sparing Hepatectomy in a Patient Presenting with Complex Synchronous Metastatic Colorectal Cancer

Caterina V¹, Lucio U², Riccardo B², Piero B4, Alessandro L4, Piero C5, Gabriella L3, Francesco F3, Maura C6, Piero B² and Gianluca M¹*

¹Medical Oncology Unit, Azienda Ospedaliero- Universitaria Pisana, Italy

²General Surgery Unit, Azienda Ospedaliero-Universitaria Pisana, Italy

³Anaesthesiology and Intensive Care Unit, Azienda Ospedaliero-Universitaria Pisana, Italy

4Radiology Unit, Azienda Ospedaliero-Universitaria Pisana, Italy

5Hepatology Unit, Azienda Ospedaliero-Universitaria Pisana, Italy

6Pathology Unit, Azienda Ospedaliero-Universitaria Pisana, Italy

*Corresponding author: Gianluca Masi, Oncologia Medica Universitaria, Azienda Ospedaliero-Universitaria Pisana, Italy

Received: November 01, 2016; Accepted: November 21, 2016; Published: November 22, 2016

Abstract

Patients who present with colorectal cancer and synchronous liver metastases are a major challenge for oncologists and surgeons. Indeed, in this setting, the treatment strategy can achieve long-term survival and sometimes a definitive cure of disease. To achieve the best results it is mandatory a dedicated multidisciplinary team that is crucial to set the overall strategy, the achievement of a significant tumor shrinkage with current systemic therapies and finally the adoption of modern surgical techniques. Here we present a case of a complex metastatic colorectal cancer who presented with synchronous unresectable liver metastases who achieved a particularly favorable outcome. Patients were successfully treated with a multimodal strategy of systemic therapies and liver sparing surgery with minor but complex liver resection.

Keywords: Colorectal cancer; Liver metastases; Parenchyma sparing surgery

Introduction

Treatment of metastatic colorectal cancer has rapidly evolved and the availability of more effective chemotherapy regimens and biological agents directed against Vascular Endothelial Growth Factor (VEGF) and the Epidermal Growth Factor Receptor (EGFR), together with the increased use of surgery on metastases, have improved median Overall Survival (OS) up to more than 30 months in recent trials, with a 10‑year OS of 20-25% for radically resected patients [1]. The majority of metastatic colorectal cancer patients have unresectable metastatic disease. However, even though in this subset immediate radicalsurgical resection is not possible, improvements in medical management of metastatic colorectal cancer have raised the possibility of achieving radical resectability of metastases in case of response to systemic treatment. The impact of secondary surgery has been definitively proved by the analysis of Adam, et al. who demonstrate that long-term survival of patients undergoing secondary resection after response to chemotherapy is similar to patients resected upfront [2]. The involvement of vital hepatic structures still remainsa major challenge for resectability. The introduction of the new concepts of the Parenchyma Sparing Hepatectomy (PSH) increases the chance of treatment [3,4] offering an oncological advantage [5]. We here present a case of a mCRC patient with unresectable disease presentation, which support the Multi Disciplinary Team (MDT) approach and the usefulness of PSH in the management of such a complex disease presentation.

Case Presentation

In February 2011, a 65 years-old man underwent abdominal ultrasonography that showed multiple liver lesions. A colonoscopy revealed a not stenotic lesion of the left colic flexure (Biopsy: adenocarcinoma). Computed Tomography (CT) of abdomen and chest showed concentric wall thickening (maximum 12 mm) charged to the proximal descending colon and extensive metastatic involvement ofthe 52% of the liver with the major lesion of 10 cm at the left hepatic lobe (Figure 1, Panel A). Baseline CEA was 680 ng/mL. Liver function tests were normal.