Recent Advances in Surgical Strategies for Managing Metastatic Colorectal Cancer

Dear Colleagues,

Colorectal cancer (CRC) is the second most lethal form of cancer worldwide, and the prognosis for metastatic CRC (mCRC) remains poor. Over the last two decades, different treatment modalities for mCRC have emerged. The introduction of molecular targeting has significantly improved patient outcomes. The availability of new chemoimmunotherapeutic protocols coupled with the possibility of integrating different surgical procedures has made it possible in recent years to create new therapeutic strategies for the treatment of metastatic disease in selected patients, especially with regard to liver and/or peritoneal surface metastases (PSMs). The treatment of metastases at other sites (lung, brain, adrenals, etc.) has also benefited from the progress achieved.

This Special Issue will collect research on the latest advances in tools and strategies to treat mCRC.

In the treatment of liver metastases, the main innovations are related to the following:

• “Parenchymal sparing” liver surgery using either a traditional or minimally invasive technique, whether associated or not associated with resection of the primary tumor;
• Advanced “parenchymal sparing” surgery: horseshoe hepatectomy, right upper transverse hepatectomy, etc.;
• The introduction of the “liver-first” approach;
• The improvement of techniques (surgical and radiological) used to increase the “future liver remnant”;
• “R1 vascular liver resection”;
• The intraoperative use of ICG to identify lesions and assess parenchyma perfusion;
• The possibility of using of liver volume 3D simulation software or an AI model to define the best “tailored” therapeutic strategies;
• The chance to use selective transarterial radioembolisation for unresectable liver cancer.

With regard to PSM, since the publication of the Prodige 7 study, cytoreductive surgery (CRS) has been recognized as a therapeutic “corner-stone”; however, the debate is still heated with regard to the below issues:

• The actual usefulness of HIPEC;
• The best HIPEC protocol;
• The roles of EPIC and PIPAC procedures;
• The best timing for chemotherapy (neoadjuvant, adjuvant, both);
• The feasibility of a minimally invasive approach

We welcome original articles on basic, pre-clinical, clinical, and translational research, as well as systematic reviews adhering to the above-described theme.

Dr. Fabrizio D'Acapito
Dr. Marco Vaira
Guest Editors

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