Resection for Colorectal Liver Metastasis

Abstract

Liver metastasis is a major cause of mortality in colorectal carcinoma (CRC). Liver resection has proved to improve the overall survival even in presence of resectable extrahepatic metastatic disease. Evaluation of resectability includes a CECT, assessment of FLR by volumetry, and PET/CT to rule out extensive extrahepatic disease. In case of synchronous liver metastasis, the outcomes of simultaneous resection of primary tumor and liver lesion has been found to be similar to the traditional primary-first approach. Laparoscopic resection is found to be safe and feasible in most liver resections with respect to oncological principles, and has also been associated with a decreased postoperative morbidity. The advent of robotic surgery has expanded the use of the minimally invasive approach for major hepatic resections and postero-superiorly placed lesions. RF ablation can be used for small, deep seated lesions especially in patients unfit for surgery. Conversion therapy can be attempted for unresectable disease using conversion chemotherapy, PVE, PVL, or ALPPS.