Current surgical strategies for the treatment of colorectal cancer liver metastases

Hepatic metastases are a common complication of colorectal cancer and affect around 50% of all patients with this disease. Surgical resection is the gold standard treatment for metastases and significantly prolongs survival. The optimum results from surgery are obtained in the following circumstances: three or fewer metastases, no extra-hepatic disease, smaller metastases, metastases confined to one lobe and clear surgical margin (> 1 cm). In patients who relapse following removal of metastases, repeat resections can Give the same degree of survival benefit as the original resection. Resection is only an option for a small proportion of patients, and most patients with hepatic metastases will present with unresectable disease. Strategies for treating initially unresectable disease include neoadjuvant chemotherapy aimed at downsizing the metastases and making them suitable for resection, with specific techniques such as cryotherapy and radiofrequency ablation combined with resection, portal embolisation and two-stage hepatectomies. (C) 2004 Elsevier Ltd. All rights reserved.