RT Book, Section
A1 Ronnekleiv-Kelly, Sean M.
A1 Weber, Sharon M.
A2 Zinner, Michael J.
A2 Ashley, Stanley W.
A2 Hines, O. Joe
SR Print(0)
ID 1160044406
T1 Treatment of Hepatic Metastasis
T2 Maingot's Abdominal Operations, 13e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9780071843072
LK accesssurgery.mhmedical.com/content.aspx?aid=1160044406
RD 2024/10/15
AB Hepatic  metastases  to  the  liver  are  significantly  more  common  than  primary  liver  malignancy  and  comprise  approximately  90%  of  hepatic  malignancies.  Each  year,  approximately  140,000  new  cases  of  colorectal  cancer  (CRC)  are  diagnosed  in  the  United  States,  with  hepatic  metastases  complicating  10%  to  25%  of  cases.1,2  Two-thirds  of  these  patients  die  from  their  disease  as  a  result  of  liver  involvement.2  In  addition,  numerous  other  malignancies  metastasize  to  the  liver.  For  instance,  approximately  50%  of  patients  with  uveal  melanoma  develop  liver  metastases  within  2  to  5  years  after  initial  diagnosis,  and  90%  of  metastatic  uveal  melanoma  patients  die  with  disease  burden  in  the  liver  due  to  inefficacious  systemic  ­chemotherapy.3  Neuroendocrine  tumors  (NETs)  also  have  propensity  to  metastasize  to  the  liver  as  well  as  breast  cancer,  esophageal  cancer,  gastric  cancer,  gastrointestinal  stromal  tumors  (GISTs),  sarcoma,  gynecologic  and  urologic  malignancies,  and  melanoma.4  Therefore,  because  of  the  significant  number  of  patients  impacted  by  either  primary  or  secondary  liver  malignancy,  there  is  an  increasing  need  for  effective  locoregional  therapy.  Surgical  resection  as  a  part  of  multimodal  therapy  is  generally  considered  the  gold  ­standard.5-8  However,  resection  is  often  not  a  reasonable  option  secondary  to  disease  burden,  tumor  location,  insufficient  estimated  future  liver  remnant,  extrahepatic  disease,  and  medical  comorbidities.  In  fact,  surgical  resection  for  metastatic  disease  to  the  liver  is  only  feasible  in  approximately  20%  of  patients.9  Therefore,  alternative  options  are  necessary  in  the  60%  to  80%  of  patients  with  metastatic  disease  to  the  liver  in  whom  surgery  is  not  possible.9  These  nonresective  techniques  are  the  focus  of  this  chapter.