Management of Metastatic Colorectal Cancer to the Liver

Colorectal cancer is the third most common cancer diagnosed in both males and females in the United States. As of January 2016 there are an estimated 1.4 million men and women living with a diagnosis of colorectal cancer, with an expected 134,490 new diagnoses and 49,190 deaths that same year. Of the projected new cases diagnosed in 2016, approximately 50% to 60% of those patients will develop metastases to the liver. It has been estimated that more than 50% of patients who die of colorectal cancer have liver metastases at autopsy and 35% have isolated hepatic metastases. Metastatic liver disease is the cause of death in most patients. The majority of patients develop metachronous metastatic lesions. However, 20% to 34% of patients present with metastatic disease to the liver at the time of diagnosis and carry a worse prognosis. Hepatic resection for colorectal metastases is the treatment of choice for patients with resected or resectable primary and regional disease if all liver disease can be treated. In this chapter, we will focus on the management of liver metastases from colorectal cancer. Our primary aim will be to provide practical treatment strategies for various clinical situations encountered by surgeons. Within this overview we will review the approach to liver resection and the supporting data. We will also outline nonresection treatment therapies that can be used in the management of metastases.