Colorectal liver metastases

Background: Despite major advances in therapies for liver metastases, colorectal cancer remains one of the commonest causes of cancer-related deaths in the UK. Sources of data: The international literature on the management of colorectal liver metastases (CLM) was reviewed. Areas of agreement: Due to a combination of highly active systemic agents and low perioperative mortality achieved by high-volume centres, a growing number of patients are being offered liver resection with curative intent. Patients with bilobar and/or extrahepatic disease who would previously have received palliative treatment only, are undergoing major surgery with good results. This review focuses on preoperative evaluation, surgical planning and the role of adjuvant therapies in the management of patients with CLM. Areas of controversy: Can ablative therapies match the outcomes of surgical resection? How can even more patients be rendered resectable? Growing points: The use of other therapies, such as radiofrequency ablation and selective internal radiation therapy. Areas timely for developing research: New chemotherapy regimens for neoadjuvant therapy and the development of new modalities of liver tumour ablation.