The 7th Joint Session between JDDW-KDDW-TDDW1(JDDW)
Thu. November 2nd   9:00 - 12:00   Room 9: Portopia Hotel Main Building Kairaku 3
Recent advances in multidisciplinary treatment for colorectal cancer
Hyun Seok Lee
Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital
Colorectal cancer (CRC) is the third most common cancer type and the second cause of cancer-related mortality in the analysis of global cancer statistics. Stage IV colorectal cancer (CRC) has heterogeneous characteristics in tumor extent and biology. The overall survival of patients with metastatic CRC has improved with the development of multimodal treatments and new chemotherapeutic drugs.
Resection of metastatic CRC is recommended when the metastatic lesions are technically present for complete removal. Before determining the resection of metastatic sites, the resectability and usefulness of locoregional surgical treatment for metastatic CRC should be fully assessed with consideration of the radiologic evaluation and the patient’s condition. In addition, clear surgical margins and technical assurance for complete resection of metastatic sites should be ensured before the surgery. Resection of metastatic CRC is performed for liver, lung, or peritoneal metastases.
Synchronous liver and primary tumor resection can be considered in patients with adequate conditions. Treatment strategies for patients with synchronous liver and CRC should be considered in conjunction with a thorough evaluation of metastatic lesions and primary tumor stages.
Solitary pulmonary metastatic lesions can be considered for surgical resection using video-assisted thoracic surgery (VATS) or open thoracotomy metastasectomy. Currently, VATS is commonly used to treat solitary pulmonary metastasis. Local ablation with radiotherapy can be used to treat lung metastasis. With the development of modern systemic chemotherapy, the treatment of pulmonary metastasis requires multidisciplinary approaches combined with surgical resection and radiotherapy and the use of accurate diagnostic imaging tools.
In the treatment of patients with CRC with peritoneal metastasis, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy can be considered. Complete surgical resections and the development of adequate chemotherapeutic agents for use against peritoneal metastatic lesions are required to prolong survival and increase treatment efficacy in patients with CRC with peritoneal metastases.
Surgical treatments should be performed in patients with symptomatic primary tumors with unresectable metastasis. However, primary tumor resection in patients with asymptomatic CRC with synchronous, unresectable metastases did not show overall survival benefits in recent studies. Therefore, the treatment of metastatic CRC is challenging due to the variable tumor extent and heterogenous characteristics. The location and extent of metastatic lesions should be considered to treat patients with stage IV CRC. Adequate surgical treatments at the appropriate time can improve survival and prevent tumor-related complications. Tailored surgical treatments and multidisciplinary approaches may improve survival and the quality of life in patients with metastatic CRC.
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