Colorectal liver metastasis (CRLM) is a condition where patients with
colorectal cancer have spread cancer to the liver. Almost 35- 40% of
patients with colorectal cancers develop CRLM during the course of the
disease. It could be synchronous – meaning the liver metastasis appears
at the same time as the primary tumor or metachronous – meaning the
liver metastasis appears after the primary tumor is treated.
In spite of this being a metastatic disease, many patients when treated
with a combination of aggressive surgery and chemotherapy survive long
and do well. The sequencing of the various modalities of treatment and
the precise planning is all-important. About 20-25 % of patients with
CRLM are eligible for liver resection surgery. Those who undergo a
successful and complete surgery will have an excellent chance of
long-term survival. Chemotherapy is an excellent tool to reduce the size
and number of CRLMs and make them suitable for surgery. Over the last
two decades, newer chemotherapy drugs, targeted therapy working at the
molecular level, and immunotherapy have increased the number of patients
who can be downsized and subsequently operated on.
Till recently, most centers would resect large parts of the liver in
order to clear the disease. this would result in long hospital stays,
liver function impairment, and result in higher morbidity or even
mortality.
Over the last few years, we have been performing IMAGE-GUIDED LIVER
PARENCHYMA SPARING SURGERY for CRLM. With the help of high-end precision
intraoperative sonography on the liver, the metastasis is mapped out in
collaboration with the radiologist. (Dr. Anirudh Kulkarni). The
lesions are then approached in such a way that minimum liver needs to be
sacrificed and yet the liver metastasis is excised. While this can be
challenging and needs a very precise understanding of the intricate
anatomy of the liver, the parenchyma sparing actually saves a lot of
liver tissue and the patients recover much faster. This enables them to
get back to routine life faster and also enables them to take their
remaining chemotherapy in time. This technique has also enabled us to
respect and offer a potential cure for those with CRLM in both lobes of
the liver.
Thanks to these advances, we are able to successfully operate and offer
potentially curative solutions to many patients with colorectal liver
metastasis.