Liver metastases : a predictive factor for the efficiency of colorectal carcinoma treatment

Jetra je najčešće sijelo metastaza različitih tumora iz cijeloga tijela, a poglavito tumora debeloga crijeva. Funkcija jetre kao glavnog sabirnog organa svih tvari iz probavnog sustava čine ju veoma privlačnom za maligne stanice. U jednoj trećini slučajeva bolesnici već u trenutku otkrivanja primarnoga tumora kolorektuma imaju prisutne metastaze u jetri, u drugoj trećini će se naknado dijagnosticirati u praćenju bolesnika, a kod treće trećine se nikada neće ni pojaviti. Problem metastatske bolesti kod takvih bolesnika ima ključnu ulogu u liječenju i daljnjoj prognozi. U današnje vrijeme tehnološkoga napretka i sveukupnog unaprijeđenja svake grane medicine postoji mnogo pristupa i modaliteta liječenja jetrenih metastaza, ali i dalje ključnu ulogu ima klasična kirurgija. Čak i unutar klasične kirurgije postoji više pristupa za odstranjenje, tj. resekciju tumorskoga tkiva. Nove spoznaje o fiziologiji jetre te o ponašanju malignih stanica uvelike su promijenile klasične operativne metode i doprinijele boljim rezultatima preživljavanja i boljoj kvaliteti života pacijenata. Važno je spomenuti i da se unatoč tome napretku mora poštivati načelo individualnosti i svakome pacijentu pristupati zasebno. Dopunske metode poput embolizacije portalne vene ili ligature portalne vene također su poboljšale rezultate kirurškoga liječenja te u nekim slučajevima neoperabilno stanje učinile operabilnim. Novim farmakološkim spoznajama i razvitkom velikog broja tzv. „pametnih lijekova“ poboljšalo se i kemoterapijsko liječenje tumora. Zajedno sa komplementarnim metodama kao što je radiofrekventna ablacija danas je moguć i palijativni pristup liječenju jetrenih metastaza i poboljšanje kvalitete preostaloga života u terminalnih pacijenata, što unazad nekoliko desetljeća nije bio slučaj. U skoroj budućnosti bit će moguć minimalno invazivni ili laparoskopski pristup kako malignim bolestima općenito tako i jetrenim metastazama na što je dan osvrt u ovome radu. Zaključno treba napomenuti da je kirurgija bila i ostala glavna kurativna metoda jetrenih metastaza i da su sve ostale metode zapravo komplementarne metode koje trebaju biti kombinirane s kirurškim tretmanom, a nikako altrenativne metode kirurgiji.The liver is the most common site of metastases from various tumours situated anywhere in the body, particularly of those caused by colorectal tumours. Its role as the primary collector of all substances from the digestive system makes the liver a highly attractive target for malignant cells. A third of the patients already present with liver metastases at the time they are diagnosed with primary colorectal tumour, in another third they will be detected during patient follow-up, while in the remaining third they will never develop. The status of metastatic disease in such patients is key to determining the course of treatment and the prognosis. Today, thanks to the technological advances and to the general progress of all branches of medicine, we have at our disposal a wide array of approaches to and modalities of treatment of liver metastases, but the role of classical surgery is still crucial. Even within classical surgery there are a number of tumour tissue removal (i.e. resection) procedures. Recent insights into the physiology of the liver and the behaviour of malignant cells have greatly impacted the classical operative methods, also increasing the survival rates and improving the patients’ quality of life. It is important to note that despite these advances the principle of individuality has to be respected, and each patient has to be approached specific to his or her needs. Complementary methods such as portal vein embolisation and portal vein ligature have also improved the results of surgical treatment, and in some cases have converted inoperable cases into operable ones. As a result of new discoveries in pharmacology and of the development of a large number of the so-called “smart drugs”, the chemotherapeutic treatment of tumours has also improved. Together with complementary methods such as radiofrequency ablation, today a palliative approach to liver metastases treatment is possible, improving the quality of the remaining lifetime for terminal patients, which a couple of decades ago was not the case. In the near future, minimally invasive and laparoscopic approaches to liver metastases and malignant diseases in general will be made possible; we discuss these in the present paper. Finally, it should be emphasised that surgery has been the curative method of choice for liver metastases, while all the other methods are purely complementary and as such are to be applied in combination with surgical treatment, never as alternatives to surgery