How to treat colorectal cancer liver

  Colorectal cancer is one of the common malignant tumors and its incidence is increasing year by year, liver is the most common metastatic site of colorectal cancer, among the confirmed cases of colorectal cancer, 20%-25% have liver metastasis, and among the surgically resected cases of colorectal cancer, 20%-25% have liver metastasis within 3 years after radical colorectal cancer surgery, and another 40%-50% will eventually have liver metastasis. Liver metastasis is the cause of colorectal cancer. Liver metastasis is the main cause of death in colorectal cancer, and how to improve the outcome of patients with liver metastasis has become one of the focal points in the field of colorectal cancer research. Colorectal cancer liver metastasis (CLM) is an important factor affecting the prognosis of colorectal cancer patients and is the leading cause of death. Therefore, improving its efficacy is an important way to improve the prognosis of colorectal cancer patients.  The inaugural meeting and the first academic meeting of the Colorectal Cancer Liver Metastasis Treatment Committee of the China Association for the Promotion of Healthcare International Exchange The meeting was held in Beijing on November 29, 2014. Hundreds of oncologists from major hospitals across China attended the meeting. The purpose and mission of this committee is to conduct extensive cooperation and carry out various clinical and basic researches on this new platform in order to improve the overall treatment level and efficacy of colorectal cancer liver metastases in China.  Multidisciplinary comprehensive treatment (MDT) is the best treatment model for colorectal cancer liver metastases (CLM), which can improve the efficacy of colorectal cancer liver metastases and benefit more patients. The Professional Committee of Colorectal Cancer Liver Metastasis Treatment of China Medical Association held the 3rd National Abdominal Tumor Summit Forum-Colorectal Cancer Liver Metastasis Diagnosis and Treatment Strategy and Practice in Beijing on April 11~12, 2015. The theme of this forum is colorectal cancer liver metastasis diagnosis and treatment strategy and experience division. The meeting invited famous scholars at home and abroad, expert teams from various fields such as colorectal surgery, hepatobiliary surgery, medical oncology, radiotherapy, diagnostics, pathology, etc. to conduct MDT exchange on typical cases, and also to discuss hot issues such as surgical timing selection, translational therapy, targeted therapy strategy.  Multidisciplinary comprehensive treatment (MDT) of colorectal cancer liver metastasis is an internationally recommended treatment model, which is similar to an expert consultation institution with a chairman and a secretary, uniting experts from various fields such as surgery, intervention, medical oncology, radiotherapy, imaging, nursing, etc., to give personalized diagnosis and standardized and planned treatment plan to each patient with colorectal cancer liver metastasis at first diagnosis, avoiding the current “The first doctor decides the patient’s treatment.  Surgery is the only means to cure liver metastasis from colorectal cancer. Unlike other tumors where the appearance of liver metastases is already at an advanced stage, liver metastases may occur at the initial diagnosis of colorectal cancer or present only in the liver, and for patients who can be surgically removed, surgical removal of liver metastases becomes the preferred treatment option, which can significantly improve the 5-year survival rate. All eligible patients should receive surgical treatment at the appropriate time. It is safe to remove both liver metastases and primary foci if complete resection of liver metastases with margins >1 cm, incision adapted to hepatectomy, and hepatectomy volume <50% is possible. The criteria for suitability for surgical resection have been evolving, challenging some of the previous relative or absolute contraindications to surgery, such as the number of tumors, incisional margins less than 1 cm, and the presence of metastases in the hilar lymph nodes. Surgically resectable extrahepatic metastatic lesions (including lung. Abdominal cavity, etc.) are no longer considered as absolute contraindications to surgery.  Neoadjuvant chemotherapy combined with postoperative chemotherapy can improve the prognosis of patients undergoing curative surgery. In patients with unresectable liver metastases at the time of initial diagnosis, neoadjuvant therapy can lead to a chance of radical surgical resection after chemotherapy in 10% - 30% of patients with a 5-year survival rate similar to that of those with stage I surgical resection of liver metastases. Preoperative neoadjuvant chemotherapy can significantly improve outcomes.  The treatment of CLM emphasizes the principles of standardization and individualization. Comprehensive treatment based on surgical resection is the key to improve the outcome of CLM, and the assessment of resectability determines the treatment strategy and treatment goals. Patients are evaluated comprehensively through the MDT treatment model, and the most reasonable treatment plan is given according to the different treatment goals. For potentially transformable unresectable CLM, aggressive combination therapy is given to downgrade the tumor and create conditions for surgery. Intensive treatment with first-line systemic chemotherapy regimens combined with molecular targeted therapy is an important approach to convert unresectable CLM to resectable.