Surgical strategies in colorectal cancer metastatic to the liver

Surgical resection remains a milestone in the treatment of colorectal metas tases to the liver. There is a distinct subset of patients who benefit from surgical resection in terms of longer survival or definitive cure. The main effort of the surg ical oncological regards the safety of the procedure and the adequacy of th e recommendation. Many studies, some of them including multivariate analysis, have shown the presence of prognostic determinants of longterm survival and prognostic ind exes of the outcome after hepatectomy. It is now accepted that liver resection should be done when the complete ex cision of all demonstrable tumor with clear resection margins is feasible. Major contra-indication is represented by the presence of extra-hepatic int ra-abdominal disease or of unresectable lung metastatic deposits. There is a wide literature indicating that in very selected patients liver reresection and multiorgan synchronous or metachronous resections are benef icial. The role of neoadjuvant chemotherapy and especially postoperative adjuvant local (intra-hepatic) and systemic chemotherapy is promising and supported by recent multicenter randomised clinical trials.