Surgery of liver metastases from colorectal cancer: the best guarantee of cure for patients.

– is estimated that one third of patients with liver metastases from colorectal origin can survive beyond the 10 years. Therefore, the MHCCR surgery is the only treatment that offers the possibility of healing

Torrevieja, November of 2011- the unit of hepatic surgery in the Hospital in Torrevieja, to address multidisciplinary way treating patients with liver Metastases of cancer colorectal (MHCCR)which is a major challenge for public assistance with around 1.2 million annual cases around the world.

At the Hospital in Torrevieja, patients with colorectal cancer are treated by a multidisciplinary team of oncologists, surgeons, anaesthetists, radiologists, pathologists and hepatólogos. Hepatic surgery unit is composed by surgeons with extensive experience in the management of this type of patient, which leads to excellent results both in terms of morbidity and mortality and long-term disease good prognosis.

It is estimated that one third of patients with liver metastases from colorectal origin can survive beyond age 10. Therefore, the MHCCR surgery is the only treatment that offers the possibility of healing and has been shown to provide clear benefits in the survival of these patients.

The liver is the most common development of MHCCR, observed in more than 25% of patients at the time of diagnosis and by up to 50-75% in the evolutionary development of the disease (in the 3 years after the diagnosis of the primary tumor). Despite the aggressiveness of the cancer, the torrevejense Center professionals argue that surgery of liver metastases offers the possibility of healing in selected patients and is recognized as the treatment of choice in this type of sick.

The median survival of patients with cancer colorectal metastatic treated with support measures is of approximately 6 months. The current treatment with chemotherapy has increased this median survival to about 20 months, liver surgery with curative intent in these patients can get survivals of over 40% at 5 years.

Liver surgery has progressed in parallel with the improvements occurred in chemotherapy, and radiology. Progress in surgical techniques has much reduced adverse effects, as evidenced by the latest series of patients undergoing resection of liver metastases with a mortality rate that ranges from 0 to 3% and less than 30 per cent morbidity.

The experience of the Hospital has a major impact on the outcome: the morbidity and mortality in liver resections decreases due to reverse to the number of cases carried out in the Center. In this sense, it is very important that the patient is treated in a hospital with a high volume of annual liver surgery, as well in the Hospital in Torrevieja.

The DRA. Amador, head of the service of General Surgery and digestive apparatus of the Hospital in Torrevieja thinks that surgical advances, progress in liver surgery and radiology and chemotherapy improvements made to increase the number of patients candidates for hepatic resection and that such treatment is carried out in hospitals where there was no one classical tradition of liver surgery as such ”. Furthermore, believes that is important that these centres be subject to audits and join international registrations where can guarantee that what you are doing is doing well, not only in terms of morbidity and mortality but also, and of course, in terms of survival ”.

Careful patient selection

Only between 10% and 20% of patients with MHCCR they initially meet the requirements for surgical resection. During the last decade, significant advances have taken place in the management of the MHCCR, especially in three areas: Oncology, radiology and surgery. These advances have increased the number of patients that may be offered surgery by up to 20-30% of cases, with a survival at 5 years from 35-50%.

The Neoadyuvante chemotherapy, which is performed before surgery, is recognized as an effective treatment to make patients suffering liver metastases that initially are not candidates for surgery, they may be, provided that they submit a response positive treatment.