Surgical resection is the “gold standard” in the treatment of secondary liver cancer
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Surgical resection is considered the only possible curative treatment for secondary liver cancer.
The indications for surgery for secondary hepatocellular carcinoma have undergone a process of continuous updating, gradual expansion of indications, and gradual improvement in efficacy. It is now generally accepted that surgical resection is the “gold standard” for the treatment of secondary hepatocellular carcinoma.
- In 1988, the European Liver Metastasis Registry reviewed 859 surgeries in 24 centers, with a 5-year survival rate of 33%, initially establishing surgical resection as the treatment of choice.
- Several large case reports since the 21st century have further confirmed the safety and efficacy of resection of liver metastases. The 5-year survival rate after surgery can be 36% to 58%.
- It is now generally accepted that surgical resection is the “gold standard” for the treatment of secondary liver cancer.
In the case of liver metastases from colorectal cancer, for example, the National Comprehensive Cancer Network (NCCN) guidelines emphasize that concurrent or staged surgical resection is preferred for resectable liver metastases.
Indications for surgical resection of secondary hepatocellular carcinoma
Our guidelines for the treatment of liver metastases from colorectal cancer also state that radical surgery can be performed in patients who meet the following criteria.
- The primary site of colorectal cancer can be R0 resected;
- The liver metastases can be completely (R0) resected with adequate liver function and a residual liver volume greater than 30%-50%, as assessed by a specialist hepatobiliary surgeon;
- The patient’s general condition allows him/her to tolerate surgery;
- No unresectable extrahepatic liver metastases.
If resection is compromised because of insufficient volume of the residual liver, radical resection can be obtained by combining chemotherapy with targeted therapy to shrink the tumor or by augmenting the volume of the liver on the side to be preserved through techniques such as portal vein embolization.
For secondary hepatocellular carcinoma of other tumor origins, such as neuroendocrine tumors, gastrointestinal mesenchymal tumors, pancreatic cancer, peri-pot belly cancer, gastric cancer, gallbladder cancer, breast cancer, lung cancer, etc., whether liver metastases can be resected can be referred to the surgical indications for liver metastases from colorectal cancer, and combined with the characteristics of the primary tumor itself, to develop a specific treatment plan.