[Surgical management of hepatic metastases from colorectal cancer]

Only complete resection offers the potential for curative treatment of hepatic metastases from colorectal carcinoma (MCRC). Surgical resection should be the first priority envisaged when confronted with MCRC. Management of MCRC has improved with major progress in hepatobiliary surgical techniques, anesthesia and intensive care techniques, and also diagnostic and therapeutic radiology, oncology, and other innovations (portal embolization, various methods for local tumor destruction). Surgical therapy must be integrated into a treatment plan concerted by a multidisciplinary oncologic management team (MOMT). The first step should be an evaluation of resectability based on technical and oncologic criteria. If resectability is feasible, surgical intervention should be proposed. If the metastases are not considered resectable at this initial evaluation, there is some possibility that the criteria of resectability can be modified by various procedures such as induction chemotherapy or portal embolization. The surgical gesture begins with a thorough exploration of the abdominal cavity, then of the liver itself with systematic intraoperative echography. Liver resection should follow the well-defined rules of oncologic hepatic surgery. Finally, it is essential for the MOMT to discuss the timing of the surgical procedure and any adjuvant treatments within the context of a concerted therapeutic strategy.