Dr. Spaggiari on Surgical Interventions 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.