Resection of colorectal liver metastases

Abstract

Introduction: The gold-standard treatment for colorectal liver metastases (CLM) is liver resection. Advances in staging, surgical technique, perioperative care and systemic chemotherapy have contributed to steady improvement in oncologic outcomes for patients following surgery in this subset of patients with stage IV colorectal cancer. The limits of resection continue to expand to include patients with more, larger and bilateral CLM, yet outcomes continue to improve with 5-year overall survival exceeding 50% following resection. Chemotherapy is an important element of treatment for patients with CLM, and chemotherapy can be combined safely with surgery to improve outcomes further.

Methods: Tailored approaches to patients include major (anatomic) resection, minor (wedge) resection, liver volumetry, and preoperative enhancement of the volume and function of the planned future remnant liver using portal vein embolization.

Results: Assessment of response to chemotherapy, analysis of liver remnant volume changes following portal vein embolization, and consideration of the surgical recovery following multistage surgical resection of bilateral CLM enable remarkable survival even among properly selected patients with extensive disease.

Conclusions: Until laboratory, pathologic, biologic, or genetic studies can define which patients will benefit most from surgical and other treatments, careful application of proven diagnostic and therapeutic approaches to patients with advanced disease will continue to allow surgeons to direct tailored, patient-centered treatment as part of a multidisciplinary team.