Mario Spaggiari, MD, transplant surgeon, Division of Transplantation, University of Illinois Health, discusses surgical strategies to improve liver remnants in colorectal cancer (CRC) with liver metastases.

The liver remnant, or how much liver is left after surgery, is an important aspect of a successful surgical resection for patients with CRC and liver metastases, Spaggiari says. As such, different surgical approaches can be utilized to increase the size of non-malignant liver in preparation for surgery, including portal vein embolization. With this strategy, the liver can be restaged after 2 to 3 weeks following portal vein embolization and then the patient can be reassessed for surgery. 

Additionally, aggressive surgical procedures that can increase the size of the liver in a shorter period can be utilized if the patient requires more immediate surgery, Spaggiari explains. For example, utilizing surgery in combination with interventional radiology allows for a patient to undergo a large surgery with a significantly increased liver remnant within a period of 7 to 15 days, Spaggiari concludes. 

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Mario Spaggiari, MD, discusses surgical strategies to improve liver remnants in colorectal cancer with liver metastases.  



Dr. Spaggiari on Surgical Strategies to Improve Liver Remnants in CRC With Liver Metastases 

Mario Spaggiari, MD, transplant surgeon, Division of Transplantation, University of Illinois Health, discusses considerations for patients with colorectal cancer (CRC) and liver metastases who have no surgical options.

Some patients with CRC and liver metastases are not considered to be surgical candidates, Spaggiari says. For example, a patient in which no segment of their liver can be spared would not be considered candidates for surgery.

However, advances in the field are increasing potential options for these patients, Spaggiari explains. For example, patients may be eligible for a hepatic artery infusion pump, which is an aggressive, liver-targeted chemotherapy. In approximately half of patients, this strategy downstages the tumor so the patient becomes eligible for surgery.

Ultimately, however, early utilization of chemotherapy is necessary in these situations because aggressive surgery does not work for patients who have disease progression on chemotherapy, Spaggiari concludes.

Mario Spaggiari, MD, discusses considerations for patients with colorectal cancer and liver metastases who have no surgical options.  



Dr. Spaggiari on Considerations for Patients With CRC and Liver Metastases Without Surgical Options 

Mario Spaggiari, MD, transplant surgeon, Division of Transplantation, University of Illinois Health, discusses the potential utility of liver transplantation as a treatment option for patients with colorectal cancer (CRC) liver metastases.

Liver transplantation as a treatment for patients with CRC liver metastases is a novel therapeutic opportunity that may come into clinical practice soon, Spaggiari says. The potential of this procedure in CRC liver metastases underscores that no matter how involved a patient’s disease is in the liver, therapeutic options could be available. Moreover, evaluating liver transplantation as a treatment strategy in the early-stage setting may be worthwhile, Spaggiari explains. 

Several clinical trials are evaluating liver transplantation in the setting of CRC liver metastases. The results of these studies could demonstrate that liver transplantation is an effective way of managing patients with CRC and unresectable liver metastases. Ultimately, novel options are emerging to treat this patient population, so patients with limited options should seek enrollment on clinical trials at academic medical centers, Spaggiari concludes.

Mario Spaggiari, MD, discusses the potential utility of liver transplantation as a treatment option for patients with colorectal cancer liver metastases.  



Dr. Spaggiari on the Potential Utility of Liver Transplantation in CRC With Liver Metastases 

Mario Spaggiari, MD, transplant surgeon, Division of Transplantation, University of Illinois Health, discusses surgical interventions in colorectal cancer (CRC) with liver metastases.

It is important to determine what aspects of patient care are handled by each specialty of a multidisciplinary care team, including medical oncology and surgery. In the realm of surgery, a deciding factor for resectability is whether a 30% liver remnant can be left, Spaggiari says. Leaving 30% of the liver means that the liver can regenerate and fulfill metabolic needs.

To determine surgical eligibility, volumetric calculations need to be made, like those needed for liver transplant, Spaggiari says. If the liver remnant is going to be too small, downstaging strategies, such as portal vein embolization, double vein embolization, ALPPS surgery, or two-stage hepatectomy, can be considered. 

Moreover, achieving an R0 resection safely can prevent patients from developing small-for-size syndrome or liver insufficiency, Spaggiari concludes.

Mario Spaggiari, MD, discusses surgical interventions in colorectal cancer with liver metastases.  



Mario Spaggiari, MD

Articles

Dr. Spaggiari on Surgical Strategies to Improve Liver Remnants in CRC With Liver Metastases

Dr. Spaggiari on Considerations for Patients With CRC and Liver Metastases Without Surgical Options

Dr. Spaggiari on the Potential Utility of Liver Transplantation in CRC With Liver Metastases

Dr. Spaggiari on Surgical Interventions in CRC With Liver Metastases