Modern Approach to Colorectal Liver Metastases

PColorectal cancer is the third leading cause of death worldwide. Approximately 15-20 % of the patients present synchronic Colorectal Liver Metastases (CRLM) and 60 % will develop them metachronicaly. Surgical treatment is the only therapy that gives these patients the option of long-term survival. In the 1980s surgical treatment offered a 5-year survival rate of approximately 20 % for patients undergoing liver resection. Recent studies show 5-year overall survival rates ranging between 42 and 58 %. Systemic chemotherapy regimens are based on fluoropirimidines. These regimes include neoadjuvant, adjuvant or both depending on the disease stage. Adjuvant chemotherapy has shown better overall survival and progression free survival in patients treated surgically for CRLM. Surgical approach to CRLM has changed dramatically in the last years. There are hardly any contraindications for treating surgically CRLM, as long as the liver remnant is at least 30 % of the total volume for non-cirrhotic non-chemotherapy treated livers. In cirrhotic or chemotherapy-treated livers this amount should reach 40 %. Aspects concerning synchronic CRLM and irresectable metastases have shown greater advances. The reverse approach or liver-first approach has offered patients with advanced disease a better option for completing total resection. Portal vein embolization, two-stage hepatectomy or ALPPS procedure (associating liver partition and portal vein ligation) are the top developments in this field showing promising results. These developments are widening surgical indications in CRLM. Surgical and systemic treatment, as well as a better understanding of molecular alterations has definitely improved the perspective for patients with CRLM. Keywords: Colorectallivermetastases; Irresectablemetastases; Synchronicmestastase