Colorectal Liver Metastases

• The liver is the most common site of metastases from colorectal cancer, and complete resection of colorectal liver metastases (CLM) is the only potentially curative treatment.

• Resection of CLM is associated with low operative mortality and long-term survival has improved, with 5-year survival rates exceeding 50%.

• Besides a potential effect on survival, preoperative chemotherapy can increase the resection rate and improve patient selection. Despite no clear benefits for initially resectable CLM, neoadjuvant chemotherapy has a crucial role in initially unresectable disease.

• Surgical strategies, such as preoperative portal vein embolization, two-stage hepatectomy and resection combined with ablation, have enabled surgical resection of multiple bilateral CLM.

• Selected patients with extrahepatic disease, mainly lung metastases, have been considered for curative resection with substantial increases in overall survival.

• Synchronous CLM can be resected after, simultaneously with, or before resection of the primary cancer, according mainly to location, symptoms, and extent of colorectal cancer and hepatic metastases. Simultaneous resection should be avoided if major resections are required for both primary and hepatic diseases.

• Surgery for hepatic recurrence of CLM results in similar overall survival to that associated with first hepatic resection, and curative surgery should be considered for each relapse.