Emerging technology in the treatment of colorectal metastases to the liver

Among patients who die from colorectal adenocarcinoma, up to 80% will develop metastatic disease of the liver. Unfortunately, the large majority of these patients are not candidates for curative hepatic resections. Advances in the systemic and regional delivery of chemotherapy and the development of novel chemotherapeutic agents have both combined to improve patient survival. Increasingly "aggressive" surgical extirpations allow more patients the opportunity for potentially curative therapy. Furthermore, the incorporation of nonresectional tumor ablation techniques into the surgeon's armamentarium may further improve the outlook for those with hepatic metastases, although the exact role of this technology remains to be determined. Additionally, new systems integrating preoperative tomographic hepatic imaging with tracked intraoperative localization devices (interactive image-guided surgery, or IIGS) may improve how the hepatic surgeon approaches focal colorectal metastases. This review examines emerging technology in the treatment of colorectal cancer that is metastatic to the liver, with a focus on new variations of formal hepatic resections, the use of ablation techniques, and the development of IIGS.