Recent Advances in Surgical Strategies for Managing Metastatic Colorectal Cancer

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Gastrointestinal Oncology".

Deadline for manuscript submissions: 15 December 2025 | Viewed by 392

Special Issue Editors


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Guest Editor
General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Via Forlanini 34, 47121 Forlì, Italy
Interests: HPB surgery; peritoneal surface malignancy; liver mets; CRS +/− HIPEC; laparoscopic surgery; colorectal cancer

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Guest Editor
Peritoneal Malignancies Surgery Program—General, Emergency and Oncological Surgery, University Hospital, Modena, Italy
Interests: CRS +/− HIPEC; -PIPAC; ILP; minimvasive oncological surgery

Special Issue Information

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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Keywords

  • metastatic colorectal cancer
  • liver metastases
  • parenchymal-sparing hepatectomy
  • staged hepatectomy
  • minimally invasive liver resection
  • cytoreductive surgery
  • HIPEC
  • PIPAC
  • peritoneal surface metastases
  • biomarker-based stratification

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Published Papers (1 paper)

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Research

13 pages, 724 KiB  
Article
Planned Liver Stereotactic Body Radiotherapy for Residual Colorectal Cancer Liver Metastases After Surgery: A Single-Arm Retrospective Study
by Sixuan Li, Dezuo Dong, Xuan Zheng, Hongzhi Wang, Kun Wang, Baocai Xing and Weihu Wang
Curr. Oncol. 2025, 32(6), 347; https://doi.org/10.3390/curroncol32060347 - 12 Jun 2025
Abstract
Given the promising outcomes of stereotactic body radiation therapy (SBRT) in treating colorectal cancer liver metastases (CRLMs), we proposed an innovative strategy combining surgery with planned liver SBRT for CRLMs. This retrospective study included patients who underwent curative-intent surgery combined with planned liver [...] Read more.
Given the promising outcomes of stereotactic body radiation therapy (SBRT) in treating colorectal cancer liver metastases (CRLMs), we proposed an innovative strategy combining surgery with planned liver SBRT for CRLMs. This retrospective study included patients who underwent curative-intent surgery combined with planned liver SBRT from July 2019 to October 2023. Planned liver SBRT was delivered to residual unresectable and unablatable lesions with maximum diameters of ≤5 cm. Outcomes included local failure (LF), intrahepatic recurrence-free survival (IHRFS), extrahepatic recurrence-free survival (EHRFS), progression-free survival (PFS), overall survival (OS), and radiation-related adverse events. A total of 69 patients were included. The 1-, and 2-year cumulative incidence rates of LF after SBRT were 7.7%, and 9.6%, respectively. The median PFS was 6.2 months, and the median OS was 45.8 months. Multivariate analysis identified RAS/BRAF mutations, extrahepatic metastases excluding lung involvement, and higher CEA as independent predictors of poorer OS. Intrahepatic recurrence was the predominant pattern of first disease progression after combination treatment. Acute grade 1–2 radiation-related adverse events occurred in 56.5% of patients, while grade 3 toxicities were reported in 4.3%. This approach offers favorable long-term outcomes, suggesting its potential to broaden the indications for curative-intent local treatments in CRLMs. Full article
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