Update on Hepatic Mets from Colo-rectal cancers (Important for AIIMS)

• Liver is the most common site of mets from colo-rectal cancers
• Liver metastasis is not a contra-indication for surgery in these patients.
• CECT is the most frequently used modality to detect these lesions
• Intra-operative USG is the most sensitive modality for these lesions
• Criteria for identifying patients who can undergo metastatectomy:
1. number of lesions (less than four, in the same lobe)
2. maximum lesion dimensions (less than 5 cm)
3. absence of metastatic spreading outside the liver, 
4. adequate (more than 1 cm) margin of healthy liver tissue for all resected lesions
5. an adequate liver remnant after resection 
• K –RAS is an independent prognostic factor in these patients
• Hepatic artery infusional chemo can be used as an adjuvant treatment in these patients.
• Bevacizumab (anti-VEGF antibody) and Cetuximab/ panitumumab (anti- EGFR) agents have been approved for management of these patients
• CUSA (Cavitron Ultrasonic Surgical Aspirator) can be used for hepatic resection""