Japanese experience with hepatic resection of KRAS-mutated colorectal liver metastases

Junichi Shindoh


RAS mutation is a well-known prognostic marker predicting patterns of recurrence and survival after resection of colorectal liver metastases (CLMs). However, there has been scarce evidence regarding the optimal choice of treatment for RAS -mutated CLMs. Indeed, RAS -mutated CLMs are at high risk of lung metastases which may preclude curative-intent treatment at the time of recurrence. Nevertheless, aggressive surgical approach using repeated resection for recurrent lesions may have prognostic advantage regardless of the RAS mutational status. As such, basic management of CLMs including careful work-up, preoperative chemotherapy for oncologically unfavorable cases, curative-intent surgery, adjuvant chemotherapy for synchronous disease, and careful follow-up including thoracic scan for monitoring the lung metastases would be important to maximize the survival outcomes of patients with CLMs irrespective of RAS mutational status.