| [ Summary ] |
Liver resection is at present the treatment of choice for patients with colorectal metastases, with 25-40% of resected patients being alive five years after treatment. Surgery used to be feasible in under 30% of patients with colorectal liver metastases, however, surgical indications have recently tended to be widened in Japan. Even patients with four or more metastatic liver deposits, or those with extrahepatic disease, often undergo liver resection. In such situations, the establishment of a risk scoring system, using independent predictors of poor outcome, is essential in making surgical treatment be an efficient strategy by excluding patients with short term recurrence after liver resection from those who are candidates for surgery. For patients with unresectable diseases, chemotherapy (systemic chemotherapy for patients with extrahepatic disease and intra-arterial chemotherapy for patients with life-threatening liver diseases), local ablation techniques [microwave coagulation technique (MCT) or radio-frequency ablation (RFA)], and, liver transplantation (in western countries), have been chosen, though long term survival cannot be obtained through these strategies. Gene therapy is expected to be a novel strategy for such patients and several phase I and II clinical studies have been performed since the late 1990s, primarily in the United States. |