Treatment of Liver Metastases from Colorectal Cancer

Abstract

Liver metastases from colorectal cancer (CRLM) represent a substantial and growing burden of disease. Prognosis is worse for patients with multiple, large, and bilobar tumors; those with high CEA and tumors with multiple genetic mutations; and patients who present with synchronous CRLM. Aggressive surgical management along with improved systemic chemotherapy over recent years has improved overall survival. Many patients undergo multiple rounds of surgery and chemotherapy and experience significant longterm survival. Using ultrasound-guided nonanatomic partial hepatectomies in combination with ablation, the modern strategy is to preserve as much normal liver parenchyma as possible while eliminating all known CRLM. Laparoscopic liver resection for CRLM has become standard of care for well-selected patients and tumors. Other techniques, such as robotic surgery and arterially directed chemotherapy, are still under investigation.