[Surgical therapy of colorectal liver metastases]

The liver is the most common organ of distant colorectal metastases. Liver resection currently represents the best and only potentially curative treatment for metastatic colorectal cancer isolated to the liver. Five-year survival rates of 30 to 40% are reported after curative liver resection. Unfortunately, only 10 to 20% of patients with liver metastases without extraheaptic disease are amenable to surgical resection. Novel therapy strategies to improve respectability such as neoadjuvant chemotherapy, portal vein embolisation or ligature, resection combined with ablation and two-stage hepatectomy are currently evaluated. The overall goal of these treatments is to increase the proportion of patients with isolated colorectal liver metastases that can undergo curative resection. Despite curative resection, 60 to 70% of patients will develop recurrent disease. In case of isolated recurrence to the liver that is resectable, repeat liver resection is the treatment of choice. Adjuvant chemotherapy is directed to reduce the risk of recurrence after resection. Despite few encouraging randomised trials on adjuvant chemotherapy, there are no definitive recommendations for adjuvant chemotherapy.