Resection of colorectal liver metastases with extrahepatic disease

Extrahepatic disease in combination with colorectal liver metastases has long been considered an absolute contraindication for surgery. However, in many reported series, long-term survival is achieved in selected patients with concomitant extrahepatic disease as long as the resection of all metastatic sites is complete. Owing to these results, an increasing number of patients with advanced metastatic colorectal disease are now being referred for surgery. For patients with concomitant liver and lung metastases, sequential resection of both disease sites has proven to be safe, offering a 5-year survival rate of more than 30%. On the contrary, hepatectomy combined with resection of regional lymph node metastases can only provide long-term survival in case of pedicular lymph node involvement. Furthermore, control of the disease by preoperative chemotherapy appears to be crucial. For peritoneal carcinomatosis, aggressive treatment combining cytoreductive surgery and intraperitoneal chemotherapy can offer a chance of prolonged long-term survival to selected patients with limited peritoneal extension. In conclusion, resection of both intra- and extrahepatic colorectal metastases should be considered if resection of all metastatic sites can be complete and the disease is controlled by chemotherapy. Long-term survival in these patients with advanced disease could be achieved if they are managed by experienced multidisciplinary teams.