Current management of colorectal liver metastases

Colorectal cancer metastatic to the liver represents an uncommon situation in surgical oncology in which metastasectomy can effect longevity and may lead to cure. Liver resection can be done safely and has drastically improved 5-year survival rates to upwards of 35%, but only a minority of patients is eligible. Advances in imaging techniques facilitate detection of metastases and improve patient selection. For unresectable patients, and as an adjunct to resection, local disease control may be achieved with cryosurgery, radiofrequency ablation, or regional chemotherapy delivered by way of infusion through the hepatic artery. Areas of ongoing investigation include regional gene therapy and interference with tumor growth by inhibition of angiogenesis.