Surgical resection of colorectal liver metastases--the current standard therapy (review)

Liver resection for colorectal metastases can be performed with curative intent in about 15-20% of patients. From a surgical point of view a radical (R0) resection is of paramount importance. Perioperative mortality is mainly linked to the extent of the liver resection (class I/II). Results of ischemic or drug induced preconditioning have been ambiguous and their clinical use is at most questionable. Five year survival following primary and repeat liver resection is consistently reported as 30-40%. Options for improvement of prognosis by purely technical means appear limited. Instead, future strategies aim at increasing the number of patients (with primarily irresectable and potentially respectable disease) amenable to curative liver resection. This could be achieved preoperatively via portal vein embolisation and neoadjuvant chemotherapy and surgically via sequential resection or a combination of surgery with local ablative therapy. All suggested modalities performed in primarily inoperable tumors should be systematically evaluated in clinical trials.