Standard surgical resection of colorectal liver metastases

Liver resection for colorectal metastases can be performed with curative intent in about 15-20% of patients. From a surgical point of view, achieving a radical (RO) resection is of paramount importance. Perioperative mortality is mainly linked to the extent of the resection (class I/II). Results of ischemic or drug-induced preconditioning have been ambiguous, and their clinical use is at most questionable. Five-year survival following primary and repeated liver resection is consistently reported at 30-40%. The options for improving prognosis by purely technical means appear limited. Instead, future strategies must aim at the conversion of primarily irresectable and potentially resectable liver metastases into resectable tumors. This could be achieved preoperatively via portal vein embolisation and neoadjuvant chemotherapy and surgically via sequential resection or a combination of surgery with local ablative therapy. All suggested modalities for primarily inoperable tumors should be systematically evaluated in clinical trials.