Hepatic resection: when, what kind, and for which patients

For the patients who develop metastatic colorectal cancer in their liver only, the option of resection of metastatic disease should be considered as a therapeutic modality. The timing of the metastases is not crucial in this decision making process. The size of the metastases is also not a factor, but the number of lesions is important for any off protocol therapy, i.e., there should be four or less lesions. How the lesions are situated is only crucial in the feasibility of resection. Thus bilobar lesions can be just as amenable to cure as unilobar but there has to be a way to leave sufficient liver parenchyma to support survival. The type of resection is also not significantly related to survival. Thus whether a lobectomy, segmentectomy, subsegmentectomy, wedge, or trisegmentectomy is necessary should be entirely up to the operating surgeon. Patients must be aware that they will have a laparotomy with at least a one third chance that a resection will not be done because of extrahepatic disease. For those who do go on to resection the question of the utility of postoperative therapy is unanswered. Promising results with postoperative hepatic artery chemotherapy have not yet been substantiated and await cooperative trial completion.