Intrabiliary metastases in colorectal cancer: a systematic review

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 26; no. 7; pp. 270 - 280
• Main Authors: Latorre Fragua, Raquel A., Manuel Vazquez, Alba, Rodrigues Figueira, Yuri, Ramiro Pérez, Carmen, López Marcano, Aylhin J., Plaza Llamas, Roberto, Ramia Ángel, Jose Manuel
• Format: Journal Article
• Language: English
• Published: Japan Wiley Subscription Services, Inc 01-07-2019
• Subjects: Biliary invasion; Biliary metastasis; Biliary Tract Neoplasms - diagnostic imaging; Biliary Tract Neoplasms - secondary; Biliary Tract Neoplasms - surgery; Biomarkers, Tumor - metabolism; Colorectal cancer; Colorectal metastasis; Colorectal Neoplasms - pathology; Hepatectomy - methods; Humans; Intrabiliary extension; Keratins - metabolism; Metastasis; Mimicking cholangiocarcinoma; Prognosis; Biliary metastasis; Colorectal metastasis; Intrabiliary extension; Mimicking cholangiocarcinoma; Biliary invasion
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.635

Background
Liver metastases emerge during the course of colorectal cancer (CRC) in 25–50% of patients. A small proportion of patients present intrabiliary growth. The absence of large series means that little is known about intrabiliary metastasis (IBM), its radiological diagnosis, the most suitable surgical techniques, and its prognostic implications.
Methods
A systematic search without limits was performed. The studies selected included patients with a diagnosis of CRC and associated IBM, either synchronous or metachronous.
Results
Of 40 studies selected, 30 were case reports and 10 case series. The median time between diagnosis and IBM was 46.7 months (range 0–180). Most CRC metastases are CK7−/CK20+. Surgical treatment performed ranged from endoscopic resection to major hepatic resections combined with pancreatectomies. It seems that patients with IBM have a better survival than patients without this metastasis.
Conclusion
In a patient with a history of CRC presenting dilatation of the bile duct, IBM should be considered. More studies are needed to determine the most appropriate type of liver resection. It is also necessary to standardize the definition and terminology of this pathology, since the existing definitions may cause confusion and make it difficult to carry out case studies and case series.
Highlight
This systematic review by Latorre Fragua and colleagues of 40 studies of colorectal cancer with associated intrabiliary metastasis revealed that diagnosis, suitable surgical techniques and prognostic implications remain understudied. Most colorectal cancer metastases were negative for cytokeratin 7 and positive for cytokeratin 20. Treatment ranged from endoscopic to major resections.