Treatment strategy for multiple hepatic metastases of colorectal carcinoma

We describe the treatment strategy for multiple hepatic metastases of colorectal carcinoma based on a review of the literature and our own results. Although a number of studies have suggested that multiplicity or bilobar distribution of metastases is associated with poor outcome, liver resection is thought to be the only potentially curative treatment. The only contraindications to surgery are the presence of extrahepatic metastases (with the exception of resectable lung metastases) and if radical removal of all detectable tumors is not possible. Hepatectomy should be performed with the aim of maintaining a delicate balance between radical removal of tumors and the preservation of as much residual hepatic mass as possible with minimal blood loss. Surgeons should be familiar with the use of intraoperative ultrasonography, a standard adjunct to liver resection. Preoperative portal vein embolization may be indicated in selected patients as a means of inducing hypertrophy in the remaining hepatic parenchyma.