Surgical Therapies for Hepatic Colorectal Metastasis

  • Laleh G. Melstrom
  • Yuman Fong
Reference work entry


The liver is the most frequent site of metastases in patients with primary colorectal cancer. Surgical resection for isolated liver disease has become progressively safer, more effective, and potentially curative. Better outcomes have prompted expansion of indications for surgery to include patients in their 70s and 80s, with multi-lobar disease, and with a small future liver remnant that are hypertrophied with portal vein embolization techniques. The clinical risk score takes into account five elements that can better predict and facilitate selection of patients who may benefit the most from surgical resection.

Simultaneous colon and liver resection in synchronous metastases has been demonstrated to be safe and the approach of choice in many high-volume centers. Ablative techniques are also being utilized with good results in patients with smaller tumors and prohibitive operative risk factors or with bilobar disease not amenable to resection. These local therapies are deemed to have better outcomes than chemotherapy alone. However, chemotherapy remains the standard adjuvant therapy in patients with resected stage IV disease. Chemotherapy is also currently being used to downstage patients who initially present with unresectable disease. However, the entity of chemotherapy-associated steatohepatitis (CASH) has been increasingly recognized and therefore preoperative chemotherapy for resectable stage IV disease has not been definitively established as the optimal approach. After resection of liver metastases, the primary sites of recurrence are the liver and lung. The best approach to optimize survival is therefore multimodal with a combination of surgery or ablative techniques for focal disease and systemic adjuvant therapy thereafter.


Liver Metastasis Liver Resection Preoperative Chemotherapy Tumor Ablation Colorectal Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of SurgeryRobert Wood Johnson and the Cancer Institute of New JerseyNew BrunswickUSA
  2. 2.Department of Surgery and RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA

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