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Biology remains the ultimate arbiter of survival in metastatic colorectal cancer. Invited commentary on “Multiple colorectal liver metastases resection can offer long-term survival. The concept of a chronic neoplastic disease.”

Published:December 16, 2022DOI:https://doi.org/10.1016/j.surg.2022.11.024
      Colorectal cancer is the 3rd most common cause of cancer and the 3rd-leading cause of death in the United States.
      • Siegel R.L.
      • Miller K.D.
      • Fuchs H.E.
      • Jemal A.
      Cancer statistics, 2022.
      Approximately 25% of patients with newly diagnosed colorectal cancer have metastatic disease at presentation, and overall, around 60% of patients will develop metastatic disease at some point during their treatment course.
      • Creasy J.M.
      • Sadot E.
      • Koerkamp B.G.
      • Chou J.F.
      • Gonen M.
      • Kemeny N.E.
      • et al.
      Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure?.
      The liver is the most common and often the only site of distant spread. While initially met with skepticism in the 1980s
      • Silen W.
      Hepatic resection for metastases from colorectal carcinoma is of dubious value.
      , liver resection with or without ablation is now widely accepted at the gold standard for liver-directed therapy in patients with technically resectable disease who are appropriate surgical candidates.
      • Creasy J.M.
      • Sadot E.
      • Koerkamp B.G.
      • Chou J.F.
      • Gonen M.
      • Kemeny N.E.
      • et al.
      Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure?.
      The group from Memorial Sloan Kettering Cancer Center recently reviewed institutional outcomes from 1,211 patients from an earlier time period (1992-2004) and reported rates of actual 10-year overall survival and cure.
      • Creasy J.M.
      • Sadot E.
      • Koerkamp B.G.
      • Chou J.F.
      • Gonen M.
      • Kemeny N.E.
      • et al.
      Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure?.
      The median disease-specific survival was approximately 5 years and estimated 10-year disease-specific survival was 34%, with an observed cure rate (defined as 10-year survival with no recurrence or resected recurrence with ≥3 years of disease-free follow-up) of 21%. There were no individual prognostic factors predictive of cure, but cure rates were <10% in patients with extrahepatic disease, margin-positive resections, carcinoembryonic antigen >200ng/ml, or >10 metastases. In patients with 5-10 liver metastases, the 10-year overall survival was 18% and observed cure rate was 13%. It must be acknowledged that without the advancements in chemotherapeutics, targeted therapy, and immunotherapy, the role and survival benefits of metastasectomy in this disease space would be far more limited.
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