Treatment of Hepatic Metastases of Colorectal Cancer, Softcover reprint of the original 1st ed. 1992 Coll. French Association of Surgery

"The experience of each one of us is the treasure of all. " Gerard de Nerval In 1952, J. L. Lortat-Jacob [2] reported the first programmed right hepatectomy, which had been carried out for a hepatic metastasis of colorectal origin. Today, excisional surgery of the liver has become a routine procedure, with a low mortality and morbi­ dity. The varieties of excision have increased and been modified in accordance with the site and number of lesions to be treated. These advances notably stem from both the work on the segmental anatomy of the liver by Couinaud [1] and that of Ton That Tung [3], which have opened the way to a simplified and segmental method of hepa­ tic resection that is both safe and reliable. This progress has been greatly facilitated by a better knowledge of the effects of vascular clamping of the liver, and by the intro­ duction of new techniques including per-operative ultrasound, the ultrasonic dissector and the argon coagulator. Improvements in anresthesia have also contributed to the safety of these procedures. The high incidence of colorectal cancer (the second commonest cause of cancer death in France) and the frequent occurrence of hepatic metastases from this tumour, more than justify the search for an effective therapeutic management pro­ tocol. The important place of surgical resection, the technical advances outlined above, and the prospect of new treatment modalities using adjuvant therapy, are additional reasons for preparing a report on this subject.

Natural history.- Epidemiology of liver metastases from colorectal cancer.- Pathology of hepatic metastases from colorectal adenocarcinomas.- Current research.- Biology of cancer invasion and liver metastases.- Experimental models of hepatic metastases of colorectal origin.- Diagnosis.- Presentation of hepatic metastases, the role of follow-up of colorectal cancer. Biochemical markers.- Imaging of hepatic colorectal metastases. Diagnosis and Resectability.- The role of intra-operative ultrasound in the surgical treatment of hepatic metastases of colorectal origin.- Radioimmunodetection of hepatic metastases of colorectal origin by means of monoclonal antibodies.- Methods of treatment.- Methods of surgical excision.- Other local treatments.- Chemotherapy of hepatic metastases of colorectal origin (systemic and local, in palliative or adjuvant treatment).- Surgical resection of hepatic metastases. Multicentric retrospective study by the French Association of Surgery.- Surgical resection of hepatic metastases. Comments on the results of the multicentric retrospective study by the French Association of Surgery.- Conclusion.- Practical therapeutic strategies.