Stratégie chirurgicale devant un patient porteur d'un cancer du côlon avec métastases hépatiques synchrones non résécables Management of patient with colonic cancer and irresectable synchronous liver metastases

At the time of diagnosis, up to 25% of patients with colorectal cancer have synchronous liver metastases and for the majority (70-90%), metastatic disease is not suitable for cure. For patients with irresectable synchronous liver metastases, it remains controversial whether first-step primary tumor resection followed by chemotherapy or up-front chemotherapy without resection of the primary is the best option.No randomized trial is available to answer this question directly and both strategies are currently practiced. Some argue that the conventional surgical approach, i.e. tumor resection followed by chemotherapy, allows precise abdominal tumor staging, prevents local complications, improves patient’s status and efficacy of chemotherapy through a reduction of tumor burden andmay favourably impact survival. In contrast, others favour a more conservative approach, i.e. first step chemotherapy reserving resection of the primary for the treatment of local complications or with a curative intent if tumor downstaging occurs. The rationale of this approach is the high mortality and morbidity rates associated with bowel resection in a metastatic setting, resulting in an increased risk of delaying or even precluding chemotherapy administration and the relatively low-risk of local complication through the effect of systemic therapy on the primary tumor. The aim of the present review is to discuss both therapeutic options taking into account the recent advances in chemotherapy with more effective drugs and the possibility of colon stenting for obstructive tumor.