Surgical management of colorectal liver metastases—a practical clinical approach

Abstract

Background: Despite the remarkable advances that have been made in the management of colorectal cancer over recent years, the optimal treatment for colorectal liver metastases (CRLM) remains a controversial matter. Undoubtedly, such a complex disease requires a multidisciplinary approach, in which close collaboration between all specialists involved in its management is of utmost importance. Methods: A literature search was conducted in PubMed. There was no limit set to the date of publication. The main focus of the literature review is to provide a comprehensive summary of the current multidisciplinary management of CRLM while highlighting the surgical approach. Results: Assessment of resectability, evaluation of the patient’s fitness, and discussion of clinicopathological features all play a vital role in finding the most suitable treatment strategy for CRLM patients, who should all be timely discussed in the multidisciplinary tumor board, in order to decide upon the optimal therapy sequence, operative time window, and postoperative treatment. Conclusion: Although hepatic resection remains the only potentially curative treatment strategy for patients with CRLM, a multidisciplinary approach is essential for optimal treatment. A clear definition of treatment goal (curative vs. palliative) at the time of disease diagnosis determines the further therapeutic course. Preoperative estimation of liver functional reserve is a key factor in the decision-making process for CRLM resectability.