Current Management of Liver Metastasis From Colorectal Cancer

Abstract

To describe the main components of modern treatment for colorectal cancer (CRC) metastatic to the liver. Liver metastasis occurs in 50–60% of patients with CRC, and surgery is the only potentially curative treatment. Surgery should be performed where a complete (R0) resection of all radiologically visible metastases is possible. The presence of extra-hepatic disease no longer precludes liver metastectomy, and combined metastectomy in the liver and the extra-hepatic site can result in acceptable long-term survival. Peri-operative chemotherapy significantly improves PFS and DFS, but not OS. Modern cytotoxic regimens can convert a significant percentage of unresectable patients to resectable status, and the addition of biologic agents can increase the rate of conversion. Several local treatment modalities serve as alternatives, or sometimes as adjuncts, to resection of CRC liver metastasis and systemic chemotherapy. The modern approach to CRC with liver metastasis combines surgery, modern cytotoxic and biologic agents, and modern technologies in the field of ablation, radiation, and endovascular access. The result is that long-term survival, and even cure, is now possible.