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In patients with colorectal liver metastases (CLMs), liver resection still represents the only potentially curative therapy. However, during the last decade, it was observed that managing the patients with CLMs in a multidisciplinary teams (MDT) will improve survival rates. Although these MDTs represent a prerequisite condition to improve the prognosis of these patients, the presence of a specialized liver surgeon in such structures allows a better allocation of the liver resection in patients with CLMs. Recent evidences revealed that liver surgeons recommended hepatectomy to a significantly higher proportion of patients with CLMs, compared with medical oncologists or other surgeons. Thus, hepatic surgeons will be able to decide the initial resectability of CLMs and to anticipate the potential for future liver resection after oncologic therapy. Therefore, the liver surgeon will contribute to establishing the goal of the treatment at the baseline. Even in patients with initially unresectable CLMs, the liver surgeon should define the criteria for resectability in order to identify as soon as possible the moment when the metastases become resectable. Moreover, an experienced hepatic surgeon will be able to anticipate the risks of postoperative complications based on the duration of preoperative chemotherapy and the volume of future liver remnant, eventually deciding to stop chemotherapy and recommending the performance of portal vein occlusion or of a “two-stage” hepatectomy. The knowledges about the necessity and the role of a hepatic surgeon in an MDT might improve the resectability rates of CLMs and translate in a better prognosis for these patients.

surgery, gastroenterology and oncology

Hepatic Surgeon in the Multidisciplinary Team Managing the Patients with Liver Metastases from Colorectal Cancer - A Prerequisite Condition to Improve Prognosis