Surgical view on the perioperative oncological treatment of liver metastases originated from colorectal cancer

Recent development of surgery resulted in fundamental changes in assessment of resectability of liver tumors. Surgical interventions became more radical and more effective. Colorectal liver metastasis (CLM) represents the most frequent hepatic tumor, where therapeutic options require close collaboration between surgeons and oncologists, and up-to-date approach from both. As the fact is, that CLM is a metastasis of a primary colorectal carcinoma, it seems to be obvious to apply perioperative chemotherapy. Results justify serious precaution. Neoadjuvant chemotherapy did not improve overall survival. Several data testify, that even perioperative chemotherapy is not indicated in these cases. Adjuvant chemotherapy can be applied after extended liver resections and two stages hepatectomies. About 20% of patients with initially inoperable CLM may be rendered resecable after systemic chemot- herapy. Prognosis of synchron CLM is bad, 5 year survival is less than 20%. Disappearing CLM needs special respect, high level of perfection in liver surgery is essential. After chemotherapy postoperative morbidity is rising, technical diffi culties may occur. Further studies are required to examine possible effect of new targeted molecular therapy-based regimens on resectability. Individualized multidiscipli- nary treatment planning is mandatory.