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Combined Resection Liver Metastases and Peritoneal Metastases

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Management of Peritoneal Metastases- Cytoreductive Surgery, HIPEC and Beyond

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Abstract

The liver and the peritoneum are two common sites for metastatic cancer spread. When there is isolated cancer spread to either of these organs, surgical resection of the metastatic disease has led to a significant improvement in the overall and disease-free survival both in selected patients compared to systemic chemotherapy alone which was previously the standard of care. At the same time, it is not uncommon for peritoneal metastases (PM) and liver metastases (LM) to occur synchronously. In patients undergoing resection of LM from various primary sites, chiefly colorectal LM, PM may be an incidental finding during the preoperative workup or during the surgical exploration itself. Similarly, in patients with PM being treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), one or more LM may be detected on preoperative imaging. Though the presence of two sites of metastases was initially a contraindication for a curative approach at either site, reports of surgical resection resulting in survival benefit have led to an adoption of this strategy for selected patients with LM and PM. Current evidence to support this approach comes from small retrospective studies; further evaluation in prospective studies is needed, and the selection criteria need to be better defined. Combined resection of LM and PM is performed for patients with metastases from colorectal cancer and epithelial ovarian cancer. Systemic therapy is used in most patients, and the role of intraperitoneal chemotherapy is less clear in these patients.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel

    Arie Ariche

  2. Department of Oncology, The Chaim Sheba Medical Center, Tel Hashomer, Israel

    Dan Aderka

  3. Department of General and Oncological Surgery (Surgery-C), The Chaim Sheba Medical Center, Tel Hashomer, Israel

    Almog Ben-Yaacov & Aviram Nissan

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  1. Department of Surgical Oncology, Fortis Hospital, Bangalore, India

    Aditi Bhatt

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Ariche, A., Aderka, D., Ben-Yaacov, A., Nissan, A. (2018). Combined Resection Liver Metastases and Peritoneal Metastases. In: Bhatt, A. (eds) Management of Peritoneal Metastases- Cytoreductive Surgery, HIPEC and Beyond. Springer, Singapore. https://doi.org/10.1007/978-981-10-7053-2_8

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