Current Surgical Management of Colorectal Cancer Liver Metastases: A Mini Review

C olorectal cancer is responsible for 10% of cancer related deaths and is the third most common cancer type in men and the second in women. Metastatic disease will develop in nearly 60% of patients with colorectal cancer, half of which will be located in the liver. At least 30% of the patients who underwent potentially curative primary tumor resection have liver micrometastases. A PubMed search of relevant articles published up to 2011 was performed to identify current information about colorectal liver metastases regarding diagnosis and management with emphasis to surgery. The results shows that hepatectomy is the only potentially curative option resulting in 5-year survival for one third of the patients, but only 10 - 30% of the patients are suitable for a radical procedure. Indications include ability to resect the tumor without residual disease, with removal of at least 1 cm of healthy tissue and clear margins, and the absence of extrahepatic metastatic disease. Specialized centers achieve mortality rate less than 5% and morbidity 20 - 50%. 5-year survival following hepatic resection is 25 - 40% with mean survival of 28 - 40 months. We conclude that current management of colorectal cancer liver metastases requires a multidisciplinary approach. Operative strategies and novel techniques that achieve wider excision areas with minimal blood loss make hepatectomy safe and effective.  doi:10.4021/jcs106e