[Resection of liver metastases--goal, timing and results]

If left to run their natural course, numerous malignant diseases will eventually produce liver metastases. Without treatment, afflicted patients have a life expectancy of only eight months. At the present time, the only therapeutic option that offers the patient with liver metastases from colorectal carcinoma the chance of a cure is resection of the metastases. Depending on the primary tumour, this also applies to some patients with carcinomas at sites other than the colorectum. A point of continuing controversy is the timing of such resection. While some authors recommend a test 'of time' ranging from several weeks to months, others call for resection of the metastases immediately after their detection. Solitary synchronous liver metastases involving only a single segment can be resected at the same time as surgical treatment of the primary when, in particular, the surgical access is readily possible and the risk of complications calculable. Most authors advocate surgery in two sessions. The location, number and size of the metastases, together with the presence of concomitant diseases, provide the basis for the decision to perform a resection. At the same time, however, the risk to the patient must be within justifiable limits. This applies in particular to non-colorectal, non-endocrine metastases. Following curative resection of colorectal hepatic metastases, 25-51% of the patients are still alive after 5 years. During the same period, some 51-76% of the patients develop a recurrence. From these data, the calculated resulting median survival for all patients undergoing resection is roughly 30 months. A tumour-free 5-year survival rate of up to 34% is achieved. In view of their different clinical course and prognosis, non-colorectal liver metastases should be classified into non-colorectal neuroendocrine (NCNE) and non-colorectal non-endocrine (NCNN) metastases. While the former group has a 5-year survival rate following curative resection of up to 62%, the figure for the latter group is only 15-35%.