Surgical management of colorectal liver metastases: a European perspective

Abstract

The treatment of colorectal cancer metastatic to the liver is increasingly complex as a result of changes in the patient population, advances in preoperative staging, changing definitions of resectability, advances in surgical technique and the expanding chemotherapeutic armamentarium. Management of these patients within a multidisciplinary team is increasingly important and associated with better outcomes. In patients with irresectable hepatic metastases, high secondary resection rates can be achieved with multiagent chemotherapy when managed in conjunction with a liver specialist. Perioperative mortality rates are reducing but morbidity remains high, and enhanced recovery could help reduce morbidity. Despite the advancing age and comorbidity of the patient population, multimodal management is likely to lead to further improvements in perioperative and long-term outcomes.

Figure 1..  Rate of liver resection following chemotherapy.

The squares represent patients in studies/retrospective analyses with nonresectable metastases confined to the liver (‘selected patients’, r = 0.96; p = 0.002; solid dark blue line). Studies with nonselected patients with colorectal cancer as shown as circles and triangles. Due to their high heterogeneity of these studies, the observed correlation is less strong (r = 0.74; p < 0.001; solid light blue line). A similar correlation was observed when the Phase III trials (triangles) were separately analyzed (r = 0.67; p = 0.024; dashed dark blue line). Reproduced from [24] with permission from Oxford University Press.