Cargando…

Precision Surgery of Colorectal Liver Metastases in the Current Era: A Systematic Review

SIMPLE SUMMARY: Colorectal cancer is among the most commonly encountered human malignancies, with up to a quarter of total patients exhibiting metastatic spread to the liver at some point during the disease course. For these patients, curative-intent liver resection yields the optimal oncological ou...

Descripción completa

Detalles Bibliográficos
Autores principales: Papaconstantinou, Dimitrios, Pararas, Nikolaos, Pikouli, Anastasia, Nastos, Constantinos, Charalampopoulos, Anestis, Dellaportas, Dionysios, Bagias, George, Pikoulis, Emmanouil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10093504/
https://www.ncbi.nlm.nih.gov/pubmed/37046744
http://dx.doi.org/10.3390/cancers15072083
_version_ 1785023602129633280
author Papaconstantinou, Dimitrios
Pararas, Nikolaos
Pikouli, Anastasia
Nastos, Constantinos
Charalampopoulos, Anestis
Dellaportas, Dionysios
Bagias, George
Pikoulis, Emmanouil
author_facet Papaconstantinou, Dimitrios
Pararas, Nikolaos
Pikouli, Anastasia
Nastos, Constantinos
Charalampopoulos, Anestis
Dellaportas, Dionysios
Bagias, George
Pikoulis, Emmanouil
author_sort Papaconstantinou, Dimitrios
collection PubMed
description SIMPLE SUMMARY: Colorectal cancer is among the most commonly encountered human malignancies, with up to a quarter of total patients exhibiting metastatic spread to the liver at some point during the disease course. For these patients, curative-intent liver resection yields the optimal oncological outcomes, ensuring long-term survival in the majority of cases. However, taking into account that liver resections are accompanied by considerable postoperative complication rates, treatment approaches should be individualized to avoid unnecessary exposure to morbid therapies. To that end, the study of tumor biology, especially in terms of RAS mutational status, is proving a very helpful adjunct in identifying patient subsets that derive the most benefit from this aggressive treatment modality. The concept of precision surgery in CRLM revolves around tailoring the aggressiveness of the employed treatments depending on tumor features, while avoiding surgery in patients not expected to derive any benefit from it. ABSTRACT: Liver resection for colorectal liver metastases (CRLM) is widely considered the treatment with the highest curative potential. However, not all patients derive the same oncological benefit, underlining the need for better patient stratification and treatment allocation. In this context, we performed a systematic review of the literature to determine the role of RAS status in selecting the optimal surgical strategy. Evidence comparing anatomical with non-anatomical resections depending on RAS mutational status was scarce and conflicting, with two studies reporting superiority in mutated RAS (mutRAS) patients and two studies reporting equivalent outcomes. The rate of incomplete microscopic resection (R1) was found to be increased among mutRAS patients, possibly due to higher micrometastatic spread lateral to the primary lesion. The impact of R1 resection margins was evaluated separately for mutRAS and wild-type patients in three studies, of which, two indicated an additive detriment to long-term survival in the former group. In the current era of precision surgery, RAS status can be utilized to predict the efficacy of liver resection in the treatment of CRLM, avoiding a potentially morbid operation in patients with adverse tumor profiles.
format Online
Article
Text
id pubmed-10093504
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-100935042023-04-13 Precision Surgery of Colorectal Liver Metastases in the Current Era: A Systematic Review Papaconstantinou, Dimitrios Pararas, Nikolaos Pikouli, Anastasia Nastos, Constantinos Charalampopoulos, Anestis Dellaportas, Dionysios Bagias, George Pikoulis, Emmanouil Cancers (Basel) Systematic Review SIMPLE SUMMARY: Colorectal cancer is among the most commonly encountered human malignancies, with up to a quarter of total patients exhibiting metastatic spread to the liver at some point during the disease course. For these patients, curative-intent liver resection yields the optimal oncological outcomes, ensuring long-term survival in the majority of cases. However, taking into account that liver resections are accompanied by considerable postoperative complication rates, treatment approaches should be individualized to avoid unnecessary exposure to morbid therapies. To that end, the study of tumor biology, especially in terms of RAS mutational status, is proving a very helpful adjunct in identifying patient subsets that derive the most benefit from this aggressive treatment modality. The concept of precision surgery in CRLM revolves around tailoring the aggressiveness of the employed treatments depending on tumor features, while avoiding surgery in patients not expected to derive any benefit from it. ABSTRACT: Liver resection for colorectal liver metastases (CRLM) is widely considered the treatment with the highest curative potential. However, not all patients derive the same oncological benefit, underlining the need for better patient stratification and treatment allocation. In this context, we performed a systematic review of the literature to determine the role of RAS status in selecting the optimal surgical strategy. Evidence comparing anatomical with non-anatomical resections depending on RAS mutational status was scarce and conflicting, with two studies reporting superiority in mutated RAS (mutRAS) patients and two studies reporting equivalent outcomes. The rate of incomplete microscopic resection (R1) was found to be increased among mutRAS patients, possibly due to higher micrometastatic spread lateral to the primary lesion. The impact of R1 resection margins was evaluated separately for mutRAS and wild-type patients in three studies, of which, two indicated an additive detriment to long-term survival in the former group. In the current era of precision surgery, RAS status can be utilized to predict the efficacy of liver resection in the treatment of CRLM, avoiding a potentially morbid operation in patients with adverse tumor profiles. MDPI 2023-03-31 /pmc/articles/PMC10093504/ /pubmed/37046744 http://dx.doi.org/10.3390/cancers15072083 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Papaconstantinou, Dimitrios
Pararas, Nikolaos
Pikouli, Anastasia
Nastos, Constantinos
Charalampopoulos, Anestis
Dellaportas, Dionysios
Bagias, George
Pikoulis, Emmanouil
Precision Surgery of Colorectal Liver Metastases in the Current Era: A Systematic Review
title Precision Surgery of Colorectal Liver Metastases in the Current Era: A Systematic Review
title_full Precision Surgery of Colorectal Liver Metastases in the Current Era: A Systematic Review
title_fullStr Precision Surgery of Colorectal Liver Metastases in the Current Era: A Systematic Review
title_full_unstemmed Precision Surgery of Colorectal Liver Metastases in the Current Era: A Systematic Review
title_short Precision Surgery of Colorectal Liver Metastases in the Current Era: A Systematic Review
title_sort precision surgery of colorectal liver metastases in the current era: a systematic review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10093504/
https://www.ncbi.nlm.nih.gov/pubmed/37046744
http://dx.doi.org/10.3390/cancers15072083
work_keys_str_mv AT papaconstantinoudimitrios precisionsurgeryofcolorectallivermetastasesinthecurrenteraasystematicreview
AT pararasnikolaos precisionsurgeryofcolorectallivermetastasesinthecurrenteraasystematicreview
AT pikoulianastasia precisionsurgeryofcolorectallivermetastasesinthecurrenteraasystematicreview
AT nastosconstantinos precisionsurgeryofcolorectallivermetastasesinthecurrenteraasystematicreview
AT charalampopoulosanestis precisionsurgeryofcolorectallivermetastasesinthecurrenteraasystematicreview
AT dellaportasdionysios precisionsurgeryofcolorectallivermetastasesinthecurrenteraasystematicreview
AT bagiasgeorge precisionsurgeryofcolorectallivermetastasesinthecurrenteraasystematicreview
AT pikoulisemmanouil precisionsurgeryofcolorectallivermetastasesinthecurrenteraasystematicreview