Hepatectomy for resectable colorectal cancer metastases - Indicators of prognosis, definition of resectability, techniques and outcomes

Hepatic metastases are present in 15% to 25% of patients at the time of diagnosis of colorectal cancer [1], and another 25% to 50% will develop liver metastases within 3 years, following resection of the primary tumor [2]. Hepatic resection for colorectal liver metastases has become the standard of care, and currently remains the only potentially curative therapy. Complete surgical resection of isolated or multiple hepatic metastases has been associated with a 25% to 50% 5-year survival. Although there are no randomized trials comparing resection and chemotherapy in patients with potentially resectable liver metastases, several retrospective studies have reviewed the outcome of patients treated nonsurgically for potentially resectable liver lesions. Those studies strongly suggested a survival advantage for patients undergoing curative hepatic resections [3,4]. Following the conventional indications for resection, only a minority of patients with colorectal liver metastases are amenable to surgery; however, all these criteria have been challenged by different groups over the past decade leading to a more aggressive approach in the management of colorectal liver metastases.