Preoperative and intraoperative approaches to improve resectability of hepatic colorectal metastases

Abstract

Given recent improvements in surgical technique and the development of more effective systemic therapies, the indications for surgical resection of colorectal liver metastases are expanding. The major limitation to the complete resection of colorectal liver metastases in the majority of patients, who present with bilobar or bulky disease, is the need to preserve a sufficient functional liver remnant. Strategies to increase the proportion of patients who are candidates for curative resection have emerged over the past several years, including neoadjuvant chemotherapy, portal vein embolization, staged and repeat hepatectomies, minimal-margin resections, ablative techniques, and the systematic resection of extrahepatic disease. The goal of all of these strategies is to permit a complete resection of all metastatic disease while preserving sufficient functional hepatic parenchyma. In this article, we review these novel strategies and discuss their impact on the increasingly complex and evolving multimodality treatment of patients with colorectal liver metastases.