Selection of Patients with Colorectal/Liver Metastases for Surgical Intervention: Current Issues and Challenges

Resection of colorectal liver metastases (CRLM) represents the best chance for cure, but appropriate selection of patients can present challenging clinical scenarios. The PubMed database was searched for articles relevant to CRLM published between 1990 and December 2013. The ability to safely achieve curative resection depends heavily on the adequacy of the future liver remnant (FLR). The FLR volume can be improved through several techniques including portal vein embolization and surgical portal vein ligation with in situ liver split (ALPPS). Disappearing liver metastases (DLM) may develop as a result of robust response to chemotherapy. Concordance between radiographic DLM and true pathologic response is poor and up to 85 % of DLM that undergo resection will demonstrate viable tumor on pathological examination. The rate of true pathologic response for lesions treated with hepatic artery infusion may be higher. Modern chemotherapeutics and techniques to improve the FLR have increased the number of patients who are candidates for potentially curative resection. In cases of DLM, curative resection should aim to include all sites of disease present prior to systemic chemotherapy if possible.