Colorectal hepatic metastasis - current therapeutic approach

Colorectal cancer remains one of the most common cancers in the developed world, and metastasis to the liver accounts for the greatest proportion of morbidity and mortality from the disease after resection of the primary cancer. With improved screening and adjuvant therapy, the survival of patients has increased substantially over the last decade. However, patients with metastatic disease often have limited survival. Hepatic metastasis is one of the most frequent sites of metastatic disease. In fact, between 35 and 55% of patients with colorectal cancer will develop hepatic metastasis sometime during the course of their disease. Patients who are able to undergo complete resection of their hepatic metastases have the best chance of long-term survival. The goal of hepatic resection is to achieve complete resection of all metastases with microscopically negative surgical margins while preserving sufficient hepatic parenchyma. Survival following hepatic resection of colorectal metastasis now approaches 35-50%; however, approximately 65% of patients will have a recurrence at five years. Increasingly, chemotherapeutic agents are being offered in the pre-operative setting prior to surgery. At the time of operation, patients with extensive hepatic disease can sometimes be offered ablative therapies combined with resection or staged approaches. Modern management of hepatic colorectal metastasis necessitates a multidisciplinary approach to effectively treat these patients and increase the number of patients who will benefit from resection.