SURGERY AND SURGICAL INNOVATIONS IN COLORECTAL CANCER (S HUERTA, SECTION EDITOR)
Current Management of Liver Metastasis From Colorectal Cancer
Published online: 8 February 2018
Springer Science+Business Media, LLC, part of Springer Nature 2018
Purpose of Review To describe the main components of modern treatment for colorectal cancer (CRC) metastatic to the liver.
Recent Findings Liver metastasis occurs in 50–60% of patients with CRC, and surgery is the only potentially curative treatment.
Surgery should be performed where a complete (R0) resection of all radiologically visible metastases is possible. The presence of
extra-hepatic disease no longer precludes liver metastectomy, and combined metastectomy in the liver and the extra-hepatic site
can result in acceptable long-term survival. Peri-operative chemotherapy significantly improves PFS and DFS, but not OS.
Modern cytotoxic regimens can convert a significant percentage of unresectable patients to resectable status, and the addition
of biologic agents can increase the rate of conversion. Several local treatment modalities serve as alternatives, or sometimes as
adjuncts, to resection of CRC liver metastasis and systemic chemotherapy.
Summary The modern approach to CRC with liver metastasis combines surgery, modern cytotoxic and biologic agents, and
modern technologies in the field of ablation, radiation, and endovascular access. The result is that long-term survival, and even
cure, is now possible.
Keywords Colorectal cancer
Liver metastasis occurs in 50–60% of patients with colorectal
cancer (CRC) [1, 2]. Although 20–34% of CRC patients pre-
sented with synchronous liver metastasis , the majority of
metastatic CRC patients are presented with metachronous liv-
er disease, diagnosed months to years after surgical resection
of the primary cancer [4, 5].
Even with modern chemotherapy regimens, surgery is still
the only potentially curative treatment option for patients with
CRC metastatic to the liver, and long-term survival is rare
without an R0 resection [6, 7]. Following complete resection,
5- and 10-year survival rates are 40 and 20%, respectively, and
median survival exceeds 40 months [8–10], as compared to a
median survival of 5–10 months without any treatment .
Recent studies report even more encouraging results, with a 5-
year survival as high as 70%, when combining resection,
modern chemotherapy, and other loco-regional treatment mo-
dalities [12–15]. Of those who survive 5 years after resection,
one-third will still have a cancer-related death, while those
who survive 10 years rarely die of the disease and are virtually
It is this solid and abundant medical literature that explains
the rationale behind the surgical treatment of CRC with liver
metastasis and drives the continuous effort to improve out-
come of this disease. In this review, we will cover the main
components of modern treatment for CRC metastatic to the
liver, with emphasis on surgical resection and other loco-
regional treatment modalities.
Since a complete R0 resection of liver metastasis is the only
treatment option associated with prolonged survival and po-
tential cure, it is now considered the treatment of choice, when
feasible. The main principles of surgical resection are
This article is part of the Topical Collection on Surgery and Surgical
Innovations in Colorectal Cancer
* Forat Swaid
Department of Surgery, University of Pittsburgh, 3459 Fifth Avenue,
Pittsburgh, PA 15213-2582, USA
UPMC Liver Cancer Center, Kaufmann Medical Building, 3471
Fifth Avenue, Suite 300, Pittsburgh, PA 15213, USA
Current Colorectal Cancer Reports (2018) 14:12–21