Clinical Oncology

[The indication for surgical resection in secondary liver malignancies - New therapeutic approaches]

LUKOVICH Péter1, PŐCZE Balázs1

AUGUST 28, 2020

Clinical Oncology - 2020;7(3)

[During the last decade liver surgery underwent major improvement: mortality rates reduced meanwhile new surgical approaches converted surgeons’ consideration on many advanced cases likely to be resectable. Liver is the most frequent site for tumor metastases and liver metastasis surgery experienced major changes as well. As long as liver resection related mortality rates have decreased indication for operative treatment of liver metastasis with certain primary tumors (stomach, pancreas) gained reconsideration and became reasonable. New surgical methods and approaches (laparoscopy, portal vein embolization) came into everyday application meantime several researches were completed enabling oncological aspect interpretation. Laparoscopy is a proven rational way of approach not only in cases of primary but metastatic liver tumors too: short and long term survival rates and oncological results are comparable with the results of open surgery. Although reports on large number series have not yet been published, it seems that practice of laparoscopy can bring increased number of cases where resection of primary tumor and synchronous liver metastasis can be performed simultaneously. Treatment strategies including surgical procedure overwhelm results of schemes planned with chemotherapy lines only even for patients suffering from advanced metastatic disease with necessary extended liver resection together with major vessel resection or for those who require liver resection following portal occlusion method. Consent opinion in best therapeutic option by oncologist and surgeon is essential to reach optimal liver metastasis patient treatment.]

AFFILIATIONS

  1. Szent János Kórház, Sebészeti Osztály, Budapest

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[It is now evident that cancer hypoxia is one of the new hallmark of cancer due to its consequences in gene expression, metabolism and biology. The importance of cancer hypoxia was recognized by the Nobel-price award in 2019. There are three major causes of cancer hypoxia: insuffi cient vascularization, systemic hypoxia of the host and constitutive activation of oncogene driven signaling pathways, all leading to a unique form of genetic reprogramming by HIF transcription factors. The consequences of HIF activation in cancer is the angiogenic phenotype, a new metabolic profi le and an immunsuppressive microenvironment. Furthermore, cancer hypoxia and the cellular adaptation lead to therapy resistance. Accordingly there is an urgent need to develop target therapies of hypoxia to improve effi cacies of various therapeutic modalities.]

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