الفهرس 
Etiology& Pathogenesis and diagnosis ofOnly 14 pages are availabe for public view
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Abstract
Colorectal cancer is the 3rd leading cause of cancer related deaths in males and females. The liver is the most common site of distant disease in colorectal cancer and approximately 60% of patients will develop liver metastases at some point during the course of their disease.
Metastatic disease of the liver was considered a lethal disease. Untreated metastatic colorectal carcinoma has a median survival of 6 to 9 months. Also using chemotherapy in the treatment of multiple colorectal cancer metastases was not so successful with median survival rate of 16.2 months.
This study reviewed the history and evolution of therapies used for the management of metastatic colorectal cancer to the liver.
Improvements in surgical technique, imaging and systemic therapy have led to expand the criteria of resectability; actually, the only sure contraindication for hepatic resection in management of multiple colorectal liver metastases is the inability to achieve margin-negative resection while ensuring sufficient hepatic reserve.
However, even this contraindication had been challenged by evolving recent modalities used to decrease the tumor size and to increase the future liver remnant helped to expand the population of patients eligible for curative-intent surgery. These modalities such as PVE, two staged operations and neoadjuvant chemotherapy had given the hope for many patients to be candidate for hepatic resection of metastases and so, to be candidate for having good survival rate.
This multimodal approach for the management of patients with colorectal liver metastasis has called for the consolidation of the concept of managing through the multidisciplinary teams that consist of variety of specialties acting together to offer those patients the best chance of cure and long-term survival.
In this study, we operated upon 30 cases, 21 cases were metachronous and 9 cases were synchronous. The cases were resectable or converted by mentioned above techniques to be resectable.
In our study, we evaluated the outcome the surgical management for multiple colorectal liver metastases, the disease that was considered formerly a lethal disease, during the duration of 12 months of the study. We were concerned mainly by the techniques were applied and we focused on the outcome in terms of morbidities and mortalities.
The procedures used were successful and efficient with no perioperative mortalities and low postoperative complications –in 20% of patients - namely biliary leakage, abdominal collection, pulmonary embolism and wound infection. All these complications were controlled easily. The recurrence of the malignant disease had been occurred in 40% of cases and the hepatic recurrence occurred only in 6% of cases. The 1year survival rate was 97%.