Liver metastases in colorectal cancer

Liver metastases in colorectal cancer are a frequent and lethal complication. Although hepatic resection is an effective treatment for patients with liver metastases in colorectal cancer, only 10-20% of the patients with liver metastases in colorectal cancer are indicated on hepatic resection. However, over the past several decades, liver resection has evolved as a safe and potentially curative treatment for liver metastases in colorectal cancer. Currently the absolute number of patients amenable to resection is large and is growing with better imaging, better surgery, and improvements in systemic therapies to reduce the risk of both intrahepatic and extrahepatic recurrences. The development of active chemotherapy and molecular targeted therapies, together with newer modalities like radiofrequency ablation, have expanded the indications for hepatic resection and improved survival. Also, although initially unresectable, a hepatic resection of colorectal liver metastases after down-sizing by using the above mentioned treatment modalities and chemotherapy can provide a hope for long-term survival that is similar to that of primarily resectable patients. To achieve this objective, for patients with liver metastases, a multidisciplinary team approach has become mandatory, with routine re-evaluation of patients and with adequate timing for each treatment.