Management of non-resectable liver metastases from colorectal cancer

Among patients who develop recurrent cancer following resection of the colorectal primary, 60-80% develop liver metastases. For such patients, liver resection is the only treatment that offers the potential for cure. Patients with four or fewer liver metastases and no apparent extrahepatic disease should be considered for resection. Patients with non-resectable liver metastases who are asymptomatic may prefer to receive no treatment until such time as symptoms occur. Those with symptomatic or rapidly progressive disease may be offered a variety of treatment approaches: Systemic chemotherapy (20% response rate); hepatic artery infusion; portal vein infusion; intraperitoneal chemotherapy; hepatic resection plus regional chemotherapy; hepatic artery ligation; hepatic artery ligation plus portal vein chemotherapy, and others. The advantages and disadvantages of each are discussed.