Treatment of liver metastases from colorectal cancer

197 cases of distant metastases from colorectal cancer (Dukes A, B, C) were diagnosed in 664 patients after curative resection of the primary tumor. Extrahepatic progress could be excluded in 98 of 142 patients with liver metastases. These 98 patients were allocated to surgical treatment (n = 17), intraarterial chemotherapy (n = 24), transarterial chemoembolization (n = 20), systemic chemotherapy (n = 10) and syptomatic therapy (n = 27) depending on the extent and localization of the disease within the liver and the patients' general condition. Curative success in 12 of 17 patients with a 5-year survival of 47% was achieved by the careful selection of patients for surgical treatment. Prolonged median survival after systemic chemotherapy (13 months), intraarterial chemotherapy (11 months) and transarterial chemoembolization of hepatic metastases (12 months) compared with the survival of patients with a symptomatic treatment only (median 11 months) could not be demonstrated, in spite o local therapeutic effects (intraarterial chemotherapy response rate 42%, transarterial chemoembolization morphologic response 82%). Effective postoperative diagnostic screening determines the percentage of potential curative surgical treatment; nonsurgical approaches failed to demonstrate prolonged survival.