Evolving techniques in the treatment of liver colorectal metastases: role of laparoscopy, radiofrequency ablation, microwave coagulation, hepatic arterial chemotherapy, indications and contraindications for resection, role of transplantation, and timing of chemotherapy.

Overview

The management of patients who have hepatic metastases from CRC has become increasingly complex as the number of modalities that is available to treat these tumors has increased. Surgical resection remains the mainstay of treatment, when possible, and may become an option in an increasing proportion of patients that has advanced disease and previously were considered unresectable when treated with a combination of neoadjuvant systemic or hepatic arterial chemotherapy. The role of microwave coagulation and RFA can be considered only complementary to surgical resection at this point, but they may represent the best option in highly selected patients, such as those who are at high risk for extrahepatic recurrence or who are poor surgical candidates.