Abstract
Background
Recent advances have extended indications for hepatectomy to include multiple bilobar colorectal liver metastases (CLM). Staging systems based on the biological malignancy of primary and metastatic tumors provide appropriate indications for hepatectomy in CLM. However, suitability for resection in patients with complex and extensive hepatic metastases is controversial.
Methods
A medline search was performed to identify papers reporting the resection for CLM. Techniques, indication, and results were reviewed.
Results
If the anticipated remnant liver volume is small (25–40% of total), suggesting a high risk of postoperative liver failure, portal vein embolization (PVE) is recommended prior to hepatectomy. However, curative resections are not always possible. Specifically in synchronous multiple bilobar CLM, two-stage hepatectomy, comprising bilateral hepatectomy and primary resection with or without PVE, can prevent growth of ipsilateral metastatic nodules in the remnant liver and reduce surgical risk. Several local ablation techniques can complement surgery if hepatic resection alone increases the risk of postoperative liver failure or is not curative. Chemotherapy combined with targeted treatment can suppress recurrence and extend indications for hepatectomy by reducing the size and number of primary irresectable tumors.
Conclusion
PVE or staged procedure combining with local ablation or neoadjuvant, downstaging or adjuvant therapies extends indications for hepatectomy to include multiple bilobar CLM. The 5-year survival rate for multiple bilobar CLM treated with alternating hepatectomy and chemotherapy is comparable to the values reported for single and hemilateral CLM.
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References
Jaeck D, Bachellier P, Guiguet M, Boudjema K, Vaillant JC, Balladur P, Nordlinger B (1997) Long-term survival following resection of colorectal hepatic metastases: Association Francaise de Chirurugie. Br J Surg 84:977–980
Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, Jaeck D (1996) Surgical resection of colorectal carcinoma metastases to the liver: a prognostic scoring system to improve case selection based on 1568 patients. Cancer 77:1254–1262
Gayowski TJ, Iwatsuki S, Madariaga JR, Selby R, Todo S, Irish W, Starzl TE (1994) Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathological risk factors. Surgery 116:703–711
Registry of Hepatic Metastases (1988) Resection of the liver for colorectal carcinoma metastases: multi-institutional study of indications for resection. Surgery 103:278–288
Minagawa M, Makuuchi M, Torzilli G, Takayama, Kawasaki S, Kosuge T, Yamamoto J, Imamura H (2000) Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long term results. Ann Surg 231:487–499
Fong Y, Cohen AM, Fortner JG, Enker WE, Turnbull AD, Coit DG, Marrero AM, Prasad M, Blumgart LH, Brennan MF (1997) Liver resection for colorectal metastases. J Clin Oncol 15:938–946
Scheele J, Stangl R, Altendorf-Hofmann A, Grube T, Hohenberger W, Stangl R, Schmidt K (1995) Resection of colorectal metastases. World J Surg 19:59–71
Ueno H, Mochizuki H, Hatsuse K, Hase K, Yamamoto T (2000) Indications for treatment strategies of colorectal liver metastases. Ann Surg 231:59–66
Shimada H, Tanaka K, Masui H, Nagano Y, Matsuo K, Kijima M, Ichikawa Y, Ike H, Ooki S, Togo S (2004) Result of surgical treatment for multiple (>5 nodules) bilobar-hepatic metastases from colorectal cancer. Langenbecks Arch Surg 389:114–121
Tanaka K, Shimada H, Togo S, Ota M, Yamaguchi I, Ike H (2001) Is hepatic resection for multiple liver metastases from colorectal carcinoma acceptable treatment? Hepatogastroenterology 48:803–807
Wood CB, Gillis CR, Blumgardit LH (1976) A retrospective study of the natural history of patients with liver metastases from colorectal cancer. Clin Oncol 2:285–288
Goslin R, Steele G Jr, Zamcheck M, Mayer R, MacIntyre J (1982) Factors influencing survival in patients with hepatic metastases from adenocarcinoma of the colon and rectum. Dis Colon Rectum 25:749–754
Neilsen J, Balslev I, Jensen HE (1971) Carcinoma of the colon with liver metastases: operative indications and prognosis. Acta Chir Scand 137:463–465
Haider MA, Amitai MM, Rappaport D, O’Malley ME, Hanbridge AE, Redston M, Lockwood GA, Gallinger S (2002) Multi-detector row CT in preoperative assessment of small (≤1.5 cm) liver metastasis: is thinner collimation better. Radiology 225:137–142
Sica GT, Ji H, Ros PR (2002) Computed tomography and magnetic resonance imaging of hepatic metastases. Clin Liver Dis 6:165–179
Giovagoni A, Marteganic A, Aiani L et al (2001) Pulse inversion US with echographic contrast media in the evaluation of hepatic metastases. Radiol Med 101:111–117
Esteban JM, Molla MA, Tomas C, Maldonado L (2002) Improved detection of liver metastases with contrast-enhanced wide band harmonic imaging: comparison with CT findings. Eur J Ultrasound 15:119–126
Ruer TJ, Langenhoff BS, Neeleman N, Jager GJ, Strijk S, Wobbes T, Corstens FH, Oyen WJ (2002) Value of positron emission tomography with [F-18]fluorodeoxyglucose in patients with colorectal liver metastases: a prospective study. J Clin Oncol 20:388–395
Minagawa M, Makuuchi M, Kubota K, Kondo Y (2004) Intraoperative three dimensional ultrasound visualization of liver vasculature. Hepatogastroenterology 51:1448–1450
Yamanaka N, Okamoto E, Kuwata E, Tanaka N (1984) A multiple regression equation for prediction of posthepatectomy liver failure. Ann Surg 200:658–663
Boerma EJ (1990) Research into the results of resection of hilar bile duct cancer. Surgery 108:572–580
Kemeny NE, Kemeny MM, Lawrens TS (2000) Liver metastases. In: Abeloff MD (ed) Clinical oncology. Churchill Livingstone, New York, pp 886–921
Goldberg RM, Sargent DJ, Morton RF, Fuchs CS, Ramanathan RK, Williamson SK, Findlay BP, Pitot HC, Alberts SR (2004) A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 22:23–30
Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, Berlin J, Baron A, Griffing S, Holmgren E, Ferrera N, Fyfe G, Rogers B, Ross R, Kabbinavar F (2004) Bevacimab plus irinotecan, fluorouracil and leukovorin for metastatic colorectal cancer. N Engl J Med 350:2335–2342
Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber J-C, Bachellier P (2004) A two-stage hepatectomy procedure combined with portal vien embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg 240:1037–1051
Adam R, Pascal G, Castaing D, Azouley D, Delvart V, Paule B, Levi F, Bismuth H (2004) Tumor progression while on chemotherapy a contra indication to liver resection for multiple colorectal metastases? Ann Surg 240:1052–1064
Johnson K, Bakhsh A, Young D, Martin TE Jr, Arnold M (2001) Correlating computing tomography and positron emission tomography scan with operative findings in metastatic colorectal cancer. Dis Colon Rectum 44(3):354–357
Selzner M, Hany TF, Wildbertt P, Mc Cormack L, Kadry Z, Clavien P (2004) Does the novel PET/CT imaging modality impact on the treatment of patients with metastatic colorectal cancer of the liver. Ann Surg 240:1026–1027
Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, Harihara Y, Takayama T (1997) Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 26:1176–1181
Soyer P, Roche A, Elias D, Levesque M (1992) Hepatic metastases from colorectal cancer: influence of hepatic volumetric analysis on surgical decision-making. Radiology 184:695–697
Henderson JM, Heymsfield SB, Horowitz J, Kutner MH (1981) Measurement of liver and spleen volume by computed tomography. Radiology 141:525–527
Penna C, Nordinger B (2002) Colorectal metastasis (liver and 1ung). Surg Clin N Am 82:1075–1090
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–321
Bulton JS, Fuhman GM (2000) Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma. Ann Surg 231:743–751
Taylor I (1985) Colorectal liver metastases—to treat or not to treat? Br J Surg 72:511–516
Tanaka K, Shimada H, Fujii Y, Endo I, Sekido H, Togo S, Ike H (2004) Pre-hepatectomy prognostic staging to determine treatment strategy for colorectal cancer metastases to the liver. Langenbecks Arch Surg 389(5):371–379
Ueno H, Mochizuki H, Hatsuse K, Hase K, Yamamoto T (2000) Indications for treatment strategies of colorectal liver metastases. Ann Surg 231:59–66
Tanaka K, Shimada H, Miura M, Fujii Y, Yamaguchi S, Endo I, Sekido H, Togo S, Ike H (2004) Metastatic doubling time: the most important predictor of survival and non-recurrence in hepatic colorectal metastasis. World J Surg 28:263–270
Fusai G, Davidson BR (2003) Strategies to increase the respectability of liver metastases from colorectal cancer. Dig Surg 20:481–496
Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, Giacchetti S, Paule B, Kunstlinger F, Ghemard O, Levi F, Bismuth H (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240:644–657
Bismuth H, Adam R, Levi F, Farabos C, Waechter F, Castaing D, Majno P, Engerran L (1996) Resection of unresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg 224:509–520
Imamura H, Kawasaki S (1999) Treatment strategy for multiple hepatic metastases of colorectal carcinoma. J Hepatobiliary Pancreat Surg 6:23–29
Rosen CB, Nagorney DM, Taswell HF, Helgeson SL, Ilstrup DM, van Heerden JA, Adson MA (1992) Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma. Ann Surg 216:493–505
Sugawara Y, Yamamoto J, Yamasaki S, Shimada K, Kosuge T, Makuuchi M (2001) Estimating the prognosis of hepatic resection in patients with metastatic liver tumors from colorectal cancer with special concern for the timing of hepatectomy. Surgery 129:408–413
Elias D, Ouellet JF, Bellon N, Pignon JP, Pocard M, Lasser P (2003) Extra hepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg 90:567–574
Pichlmayer R (1988) Is there a place for liver grafting for malignancy. Transplant Proc 20:478–482
Azouley D, Castaing D, Smail A, Adam R, Cally V, Laurent A, Lemoine A, Bismuth H (2000) Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg 231:480–486
Makuuchi M, Thai BL, Takayasu K, Takayama T, Kosuge T, Gunnven P, Yamazaki S, Hasegawa H, Ozaki H (1990) Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 107:521–527
Harada H, Imamura H, Miyagawa S, Kawasaki S (1997) Fate of human liver after hemihepatic portal vein embolization: cell kinetic and morphometric study. Hepatology 26:1162–1170
Kokudo N, Tda K, Seki M, Ohta H, Azekura K, Ueno M, Ohta K, Yamaguchi T, Matsubara T, Nakajima T, Muto T, Ikari T, Yanagisawa A, Kato Y (2001) Proliferative activity of intrahepatic colorectal metastases after preoperative hemi-hepatic portal vein embolization. Hepatology 34:267–272
Fujii Y, Shimada H, Endo I, Kamiyama M, Kamimukai N, Tanaka K et al (2000) Changes in clinicopathological findings after portal vein embolization. Hepatogastroenterology 47:1560–1563
De Baere T, Roche A, Elias D, Lasser P, Lagrange C, Bousson V (1996) Preoperative portal vein embolization for extension of hepatectomy indications. Hepatology 24:1386–1391
Adam R, Laurent A, Azouley D, Castaing D, Bismuth H (2000) Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 232:777–785
Togo S, Nagano Y, Masui H, Tanaka K, Miura Y, Morita D, Endo I, Sekido H, Ike H, Shimada H (2005) Two-stage hepatectomy for multiple biolobular liver metastases from colorectal cancer. Hepatogastroenterology 52:913–919
Bakalakas EA, Kim JA, Young D, Martin EW Jr (1998) Determinants of survival following hepatic resection for metastactic colorectal cancer. World J Surg 22:399–405
Ekberg H, Tranberg KG, Andersson R, Lundstedt C, Hagerstrand I, Ranstam J, Bengmark S (1986) Determinants of survival in liver resection for colorectal secondaries. Br J Surg 73:727–731
Cady B, Jenkins RL, Steele GD Jr, Lewis WD, Stone MD, McDermott WV, Jessup JM, Bothe A, Lalor P, Lovett EJ, Lavin P, Linehan DC (1998) Surgical margin in hepatic resection for colorectal metastasis: a critical and improbable determinant of outcome. Ann Surg 227:566–571
Shirabe K, Takenaka K, Gion T, Fujiwara Y, Shimada M, Yanaga K, Maeda T, Kajiyama K, Sugimachi K (1997) Analysis of prognostic risk factors in hepatic resection for metastatic colorectal carcinoma with special reference to the surgical margin. Br J Surg 84:1077–1080
Yasui K, Hirata T, Kato T, Torii A, Uesaka K, Morimoto T, Kodera Y, Yamamura Y, Kito T, Hamajima N (1997) A new macroscopic classification predicts prognosis for patient with liver metastases from colorectal cancer. Ann Surg 266:582–586
Elias D, Caralcanti A, Sabourin JC, Pignon JP, Dureux M, Lasser P (1998) Result of 136 curative hepatectomies with a safety margin of less than 10 mm for colorectal metastases. J Surg Oncol 69:88–93
Nanko M, Shimada H, Yamaoka H, Tanaka K, Masui H, Matsuo K, Ike H, Oki S, Hara M (1998) Micrometastatic colorectal cancer lesion in the liver. Surg Today 28:707–713
Fuhrman GM, Curley SA, Hohn DC, Roh MS (1995) Improved survival after resection of colorectal liver metastases. Ann Surg Oncol 2:537–541
Steele G Jr, Bleday R, Mayer RJ, Lindblad A, Petrelli N, Weaver D (1991) A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: gastrointestinal tumor study group protocol 6584. J Clin Oncol 9:1105–1112
Altendorf-Hofmann A, Scheele JA (2003) A critical review of the major indicators of prognosis after resection of hepatic metastases from colorectal carcinoma. Surg Oncol Clin N Am 12:165–192
Pawlik TM, Scoggins CR, Zorzi O, Abdalla EK, Andre A, Eng C, Curley SA, Loyer EM, Muratore A, Mentha G, Capussotti L, Vanthey JN (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241:715–724
Yamamoto J, Sugihara K, Kosuge J, Takayama T, Shimada T, Yamasaki S, Sakamoto M, Hirohashi S (1995) Pathological support for limited hepatectomy in the treatment of liver metastasis from colorectal cancer. Ann Surg 221:74–78
Kokudo N, Miki Y, Sugai S, Yanagisawa A, Kato Y, Sakamoto Y, Yamamoto J, Yamaguchi T, Muto T, Makuuchi M (2002) Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection. Arch Surg 137:833–840
Sheele J, Stangle R, Altendorf-Hoffmann A et al (1991) Indications of prognosis after hepatic resection for colorectal secondary. Surgery 110:13–19
Rous P, Larimore LD (1920) Relation of the portal flow to liver maintenance. A demonstration of liver atrophy conditional to on compensation. J Exp Med 31:609–632
Abdalla EK, Vauthey J-N, Ellis LM, Ellis V, Pollock R, Broglio KR, Hess K, Curly SA (2004) Recurrence and anticome following hepatic resection, Rf and combined resection/ablation for colorectal liver metastases. Ann Surg 239:818–827
de Baere T, Roche A, Elias D, Lasser P, Lagrange C, Bousson V (1996) Preoperative portal vein embolization for extension of hepatectomy indications. Hepatology 24:1386–1391
Vauthey JN, Chaoui A, Do KA, Bilimoria MM, Fenstermacher MJ, Charsangavej C, Hicks M, Alsfasser G, Lauwers G, Hawkins IF, Caridi J (2000) Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical association. Surgery 127:512–519
Nagino M, Nimura Y, Kondo S, Kanai M (1996) Selective percutaneous transhepatic embolization of the portal vein in preparation for extensive liver resection: the ipsilateral approach. Radiology 200:559–563
Uesaka K, Nimura Y, Nagino M (1996) Changes in hepatic lobar function after right portal vein embolization. An appraisal by biliary indocyanine green excretion. Ann Surg 223:77–83
Nagtano Y, Nagahori K, Fujii Y, Hamaguchi Y, Ishikawa T, Ichikawa Y, Togo S, Okazaki Y, Hayashizaki Y, Shimada H (2004) Gene expression profile analysis of regenerating liver after portal vein ligation in rats by a cDNA microarray system. Liver Int 24:253–258
Elics D, De Baare T, Roche A, Ducreaux M, Leclere J, Lasser P (1999) During liver regeneration following right portal embolization, the growth rate of liver metastases is more rapid than that of the liver parenchyma. Br J Surg 86:784–788
Kianmanesh R, Farges O, Abdalla EK, Sauvanet A, Ruszniewski P, Belghiti J (2003) Right portal vein ligation: a new planned two-step all surgical approach for complete resection of primary gastrointestinal tumors with multiple bilateral liver metastases. J Am Coll Surg 197:164–170
Petrowski H, Goren M, Janargen W, Loreng M, Dematteo R, Heinrich S, Encke A, Blumgart L, Fong Y (2002) Second liver resections are safe and effective treatment for recurrent hepatic metastases from colorectal cancer. Ann Surg 235:863–871
Shibata T, Niinobu T, Ogata N, Takami M (2000) Microwave coagulation therapy for multiple hepatic metastases from colorectal carcinoma. Cancer 89:276–284
Morita T, Shibata T, Okuyama M, Ikeda K, Takahara Y, Kitada M, Takashi S (2004) Microwave coagulation therapy for liver metastases from colorectal cancer. Jpn J Cancer Chemother 31(5):695–699
Ruers TJ, Josten J, Jager GJ, Wobbes T (2001) Long-term results of treating hepatic colorectal metastases with cryotherapy. Br J Surg 88:844–849
Grothey A, Schmoll HJ (2001) New chemotherapy approaches in colorectal cancer. Curr Opin Oncol 13:275–286
Masi G, Allegrini G, Danesi R, Di Paulo A, Cupini S, Marcucci L, Pfanner E, Brunetti I, Conte P-F, Del Tacca M, Falcone A (2002) Bi-weekly irinotecan (CPT-11), oxaliplatin (LOHP), leucovorin (LV) and 5-fluorouracil (5-FU) 48 hrs. continuous infusion in advanced colorectal cancer (ACRC). Proc Am Soc Clin Oncol 21:169a
Ellis LM, Hoff PM (2004) Targeting the EGFR: an important incremental step in the battle against colorectal cancer. J Clin Oncol 22:1177–1179
Saltz LB, Meropol NJ, Joehrer RJ, Needle MN, Kopit J, Mayer R (2004) Phase II trial of cetuximab in patients with refractory colorectal cancer that express the EGFR. J Clin Oncol 22:1201–1208
Chung KY, Shia J, Kemney NE, Shah M, Schwartz GK, Tse A, Hamilton A, Pan D, Schrag D, Schwartz L, Klimstra DS, Fridman D, Kelsen D, Saltz LB (2005) Cetuximab shows activity in colorectal cancer patients with tumors that do not express the EGFR by immunohistochemistry. J Clin Oncol 23:1803–1809
Sparano JA, Gray R, Gianoti BO, Dwyer P, Comis RL (2004) Evaluating antiangiogenesis agents in the clinic: the eastern cooperative oncology group portfolio of clinical trial. Clin Cancer Res 10:1206–1211
Ashele C, Lonardi S, Monfardini S (2002) Thymidylate synthase expression as a predictor of the clinical response to fluoropyrimidive-based chemotherapy in advanced colorectal cancer. Treat Rev 28:27–47
Loreng M, Resion I (1995) Adjuvant and palliative regional therapy of liver metastases in colorectal tumors. Dtsch Med Wochenschr 120:690–697
Benson AB (1998) Therapy for advanced colorectal cancer. Semin Oncol 25:2–11
Kemeny MM, Adak S, Gay B, Macdonald JS, Smith T, Lpsitz S, Sigundson ER, Dwyer JO, Benson AB (2002) Combined modality treatment for respectable metastaic colorectal carcinoma to the liver. J Clin Oncol 20:1499–1505
Tanaka K, Adam R, Shimada H, Azouley D, Levi F, Bismuth H (2003) Role of neoadjuvant chemotherapy in the treatment of multiple colorectal metastases to the liver. Br J Surg 90:963–969
Allen PF, Kemeny N, Jarnegin W, Dematteo R, Blumgardt L, Fong R (2003) Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal time metastases. J Gastrointest Surg 7:109–117
Cholett P, Amat S, Cure H, de Latour M, Le Bouedec G, Mouret-Reynier MA, Ferriere JP, Achard JL, Dauplat J, Penault-Llorca F. (2002) Prognostic significance of a complete pathological response after induction chemotherapy in operable breast cancer. Br J Cancer 86:1041–1046
Tabira Y, Yasunaga M, Sakaguchi T, Nagamoto N, Ogi S, Kitamura N (2000) Predicting initial recurrence pattern of esophageal cancer after neoadjuvant chemotherapy. Hepatogastroenterology 47:1315–1318
Miyanari N, Mori T, Takahashi K, Yasuno M (2002) Evaluation of aggressively treated patients with unresectable multiple liver metastases from colorectal cancer. Dis Colon Rectum 45:1503–1509
Clavien PA, Selzner N, Morse M, Selzner M, Paulson E (2002) Downstaging of hepatocellular carcinoma and liver metastases from colorectal cancer by selective intra-arterial chemotherapy. Surgery 131:433–42
Catalano V, Baldelli AM, Giordani P, Cascinu S (2001) Molecular marker predictive of response to chemotherapy in gastrointestinal tumor. Crit Rev Oncol Hematol 38:93–104
Ashele C, Debernardes D, Londardi S, Bandelloni R, Casezza S, Monfardini S, Gallo L (2004) Deleted colon cancer protein expression in colorectal cancer metastasis. J Clin Oncol 22:3758–3765
Tanaka T, Tanimoto K, Otani K, Satoh K, Ohtaka M, Yoshida K, Toge T, Yahata H, Tanada S, Chayama K, Okazaki Y, Hayashizaki Y, Hiyama K, Nishiyama M (2004) Concise prediction models of anticancer efficacy of 8 drugs using expression data from 12 selected genes. Int J Cancer 111:617–626
Ghadimi BM, Grade M, Di Filippantonio MJ, Varma S, Simon R, Montagner C, Fuzesi L, Langen C, Becker H, Liersch T, Ried T (2005) Effectiveness of gene expression profiling for response prediction of rectal adenocarcinomas to preoperative chemotherapy. J Clin Oncol 23:1826–1838
Shrag D, Garewal HS, Burstein HF, Samson DJ, von Hoff DD, Mark R (2004) American society of clinical oncology technology assessment: chemotherapy sensitivity and resistance assay. J Clin Oncol 22:3631–3638
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Shimada, H., Tanaka, K., Matsuo, K. et al. Treatment for multiple bilobar liver metastases of colorectal cancer. Langenbecks Arch Surg 391, 130–142 (2006). https://doi.org/10.1007/s00423-005-0003-7
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DOI: https://doi.org/10.1007/s00423-005-0003-7