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In Western countries, colorectal cancer is the fourth leading cause of cancer. In the US it is the second most common cause of cancer-related mortality. Unfortunately, about 35–55% of patients with colorectal cancer develop hepatic colorectal metastases. At present, surgical resection of these lesions represents the main therapeutic option and is the only chance for cure and long-term survival. In patients with extensive metastatic disease who are not candidates for resection only, radiofrequency ablation (RFA) can be combined with hepatectomy.
While the principal goal of hepatic resection is to resect all metastases with negative histological margins, preservation of adequate liver parenchyma must be considered. The utilisation of portal vein embolisation (PVE) and neoadjuvant chemotherapy may lead to increased candidacy for surgical treatment of such colorectal metastases. Although a fraction of patients develop recurrent disease after hepatic resection, newer and more biologically active chemotherapeutic agents are available that may prolong both diseasefree and overall survival. The current therapeutic options for hepatic colorectal metastases necessitate a multidisciplinary approach that involves surgeons, oncologists and radiologists in order to increase the number of patients who are candidates for the surgical treatment of colorectal cancer liver metastasis.
In the US there are approximately 150,000 new cases of colorectal cancer annually, accounting for more than 55,000 cancer-related deaths.1 Unfortunately, approximately 50% of these patients will develop hepatic colorectal metastases.2 Of these patients, 15–25% present with synchronous hepatic lesions,3–5 while another 20–25% will develop metachronous liver disease.6–8 Furthermore, in one-fifth of these patients the liver is the only site of metastatic disease.9 As a result, there are approximately 10,000–15,000 patients each year who are candidates for surgical resection of their hepatic colorectal metastases.8 Surgical resection of hepatic metastases remains the only therapeutic option with the potential for long-term cure.10
Long-term survival and potential cure following surgical resection for hepatic colorectal metastases have been demonstrated in numerous studies. The overall five-year survival rate reported after hepatectomy with curative intent ranges from 35 to 58%.10–19 These results are expected to improve even further with a multidisciplinary approach that includes newer chemotherapy regimens.20 As such, resection of colorectal liver metastasis should be considered standard practice. Furthermore, many traditional factors that were previously considered absolute contraindications to hepatic resection have recently been called into question. For example, even very well selected patients with extrahepatic metastatic disease may now be considered potential candidates for hepatic resection.21,22 Herein, we review the issues relating to the therapeutic management of patients with colorectal liver metastases.