Review article:multimodality treatment of liver metastases increases suitability for surgical treatment

BackgroundLiver metastases of colorectal cancer occur frequently, but only 10-20% are eligible for liver surgery. Recent new developments changed the concepts of treating patients with colorectal liver metastases.AimTo describe the available modalities that can result in increasing resectability rate.MethodsPotentials and drawbacks of portal vein embolization, radiofrequency ablation (RFA), trans-ablated tumour hepatectomy, neoadjuvant chemotherapy and the approach to patients with extrahepatic metastases are described.ResultsPortal vein embolization is a well-established technique to increase the volume of the future liver remnant. RFA should be applied if partial liver resection alone cannot make the liver tumour-free. Neoadjuvant chemotherapy in patients with unresectable liver metastases can result in secondary resectability rates of 15-40%. Hepatotoxicity can lead to a higher complication rate after partial liver resection. A limited number of extrahepatic tumour localizations should be resected as well.ConclusionsA more aggressive approach to patients with colorectal liver metastases improves resectability rate and survival. Unfortunately, these new options have not been thoroughly evaluated in randomized controlled trials. For some of these modalities, the currently available results are so promising that it might be difficult to start such trials in the future.