What is the optimal resection strategy for an elderly patient with sigmoid colon cancer and multiple metastases in the right liver lobe?

From the Guidelines

For an old, aged patient with sigmoid colon cancer with multiple metastases in the right liver lobe, the most appropriate resection strategy would be option D: Staged 1ry then 2ry. This approach is supported by the most recent and highest quality study, which emphasizes the importance of a personalized treatment plan for patients with metastatic colon cancer 1. The study suggests that for patients with resectable metastatic colon cancer, surgical resection is a potentially curative treatment option, and a staged approach may be considered to balance oncological benefit against surgical risk. The Chinese Society of Clinical Oncology (CSCO) guidelines recommend that the order of surgical resection for primary and metastatic lesions in synchronous metastatic colon cancer, including simultaneous or staged surgery, mainly depends on the physical conditions of patients and comprehensive assessments of surgical tolerance and safety 1. In this case, a staged approach, where the primary tumor is resected first, followed by resection of the metastatic lesions, may be the most appropriate strategy, as it allows for the immediate risk of complications from the primary tumor to be addressed while also considering the patient's overall health and surgical risk. Additionally, the study highlights the importance of neoadjuvant chemotherapy in reducing tumor size and increasing the R0 resection rate, which may be considered in the treatment plan for this patient 1. Overall, a staged approach, with primary tumor resection followed by resection of the metastatic lesions, prioritizes the patient's quality of life and symptom control while also considering the potential for curative treatment. Key considerations in this approach include:

• The patient's overall health and surgical risk
• The potential benefits and risks of neoadjuvant chemotherapy
• The importance of a multidisciplinary discussion in determining the best treatment plan
• The need for close follow-up and monitoring to adjust the treatment plan as necessary.

From the Research

Resection Strategy for Sigmoid Colon Cancer with Multiple Metastases in Right Liver Lobe

• The optimal resection strategy for an old, aged patient with sigmoid colon cancer and multiple metastases in the right liver lobe is a topic of discussion in the medical field.
• According to the studies, there are different approaches to treating this condition, including:
  • Synchronous resection of the primary tumor and liver metastases 2
  • Staged resection, where the primary tumor is resected first, followed by resection of the liver metastases 3, 4
  • Resection of the liver metastases only, in cases where the primary tumor is not resectable 5
• The choice of resection strategy depends on various factors, including the patient's overall health, the extent of the disease, and the potential for achieving complete resection of the tumor.
• Studies have shown that aggressive resection of multiple liver metastases can be an effective therapy for selected patients with recurrent colon cancer 5.
• Neoadjuvant chemotherapy can also be used to downstage the disease and improve the chances of successful resection 2.
• In some cases, chemotherapy may be used as the primary treatment, especially in patients with severe liver dysfunction or those who are not candidates for surgery 6.
• The treatment approach should be individualized and based on a multidisciplinary discussion between surgeons, medical oncologists, and other healthcare professionals.