Regional Hepatic Therapies for Colorectal Hepatic Metastases

The modern era of hepatic resection began with the first published report on "formal" right hemi-hepatectomy by Jean Louis Lortat-Jacob in France in 1952.1 Advanced imaging has enabled improved patient selection for potentially curative resection.2 Dramatic clinical and technical innovations over the last several decades have resulted in >50% five-year survival for patients undergoing resection; however, only about 25% patients with colorectal hepatic metastases (CRHM) will be candidates for operation.3 Given this modest rate of resectability, most patients will require a combination of systemic and local non-surgical therapies  In this patient population, besides systemic chemotherapy, treatment modalities collectively termed "regional hepatic therapies (RHT)" may be employed. RHT include trans-arterial chemotherapy, hepatic artery infusion (HAI) pumps, trans-arterial radio-embolization (TARE) with Yttrium-90 (Y-90) and thermal tumor ablation using radiofrequency ablation (RFA) or microwave ablation (MWA). 4   In this review, we introduce RHT and discuss their utility in the modern day.