Surgical management of colorectal liver metastases

Abstract

O utcomes of stage IV colon cancer have improved dramatically in the past decade. In fact, overall survival rates in the subset of stage IV patients with colorectal liver metastases who undergo hepatic resection have doubled compared with pre-1992 rates. At least three single-institution studies1–3 and one multi-institutional study4 have reported a 5-year overall survival rate of 58% after resection of colorectal liver metastasis. Outcomes after resection of solitary colorectal liver metastasis are even better, with a 5-year overall survival rate of 71%.5 This extraordinary improvement in survival has occurred despite expanding criteria for resection, including multiple tumors, bilateral tumors, and larger tumors, and—among highly selected patients—the presence of extrahepatic disease. Certainly, these improvements have resulted from many factors, including better patient selection for aggressive therapy, use of modern imaging techniques, better chemotherapy, safer extensive hepatic surgery, and better perioperative care—but most importantly because care is multidisciplinary and individualized to each patient. This article summarizes the current state-ofthe-art treatment of colorectal liver metastases. It details patient selection for resection, surgical techniques including liver enhancement techniques, Surgical management of colorectal liver metastases