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Practitioners’ Corner (continued)
shortened. The patients can be restarted on postoperative sys- temic chemotherapy much earlier. A delay in restarting postop- erative chemotherapy results in survival disadvantage.
Cure is considered after a 10-year survival without the dis- ease. Recurrent disease at this point is less likely. Repeat liver re- section is feasible in many patients and those patients can reach an overall 5-year survival up to 40%. In cases of recurrent liver metastasis, chemotherapy administered systemically or locally (chemoembolization or radioembolization) plays a palliative role and is rarely significant to prolong survival. Even with the improvement in the chemotherapy and biological agents, sur- vival is rarely >3 years without liver surgery.
vasive surgery as well as complex hepatic surgery. In a special- ized hepatobiliary center such as ours, minimally invasive ro- botic liver resection is undertaken routinely for both first-time liver resection and repeat liver resection. Since 2016, we have completed almost 300 robotic liver resections. We also under- take combined colon and liver resection on a regular basis. In fact this is our preferred approach to avoid a second operation, whenever possible. In conclusion, treatment strategy for liver metastasis from colorectal cancer has evolved significantly in the last two decades. Liver resection now plays a main role in treatment of this disease due to proven survival benefits, in con- junction with chemotherapy.
References available upon request.
Since early 2010, minimally invasive technique in liver sur- gery has gained popularity due to improved clinical outcomes when compared to open liver surgery. Less postoperative pain, shorter recovery, earlier return of bowel function, lower post- operative complications including wound infection and hernia formation are clear advantages of minimally invasive technique. For patients who require postoperative chemotherapy, mini- mally invasive technique also facilitates much earlier start. This technique, however, requires advanced skills in minimally in-
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HCMA Bulletin Ad.indd 1
9/28/2015
2:23:54 PM
HCMA BULLETIN, Vol 65, No. 5 – January/February 2020
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