Review Surgical management of hepatic metastases from colorectal malignancies

Liver metastasis represents the major cause of death of pa-tients who have been treated for colorectal adenocarcinoma. Spontaneous survival rarely exceeds two years. Surgery can offer long-term survival and resection should be considered when liver metastases can be totally resected with clear mar-gins and when there is no non-resectable extra-hepatic disease. The choice between anatomical or wedge resection depends on the number and the location of the metastases but does not influence survival. Clamping methods limit blood loss. Operative mortality is generally less than 5%. The five-year survival rate after surgical resection varies from 20 % to 45% according to several prognostic factors. The longer survival is observed in patients with fewer than four lesions, with lesions smaller than 4 cm, without extra-hepatic disease, with lesions that appeared more than two years after the resection of a stage I or II colorectal cancer and whose CEA level is normal. After resection, follow-up can detect hepatic recurrence that can be treated with repeat hepatectomy. The efficacy of sys-temic chemotherapy using new agents can increase the number of patients amenable to surgery. Regional therapies with cryo-therapy or radiofrequency ablation can help to treat unresect-able or non-totally resectable lesions and may improve survival. The effects on survival of adjuvant treatments, including pre-or postoperative systemic or postoperative intra-arterial che-motherapy, are currently under evaluation. Key words: adjuvant chemotherapy, colorectal cancer, liver metastases, surger