The indication for surgical resection in secondary liver malignancies – New therapeutic approaches

During the last decade liver surgery underwent major improvement: mortality rates reduced meanwhile new surgical approaches converted surgeons’ consideration on many advanced cases likely to be resectable. Liver is the most frequent site for tumor metastases and liver metastasis surgery experienced major changes as well. As long as liver resection related mortality rates have decreased indication for operative treatment of liver metastasis with certain primary tumors (stomach, pancreas) gained reconsideration and became reasonable. New surgical methods and approaches (laparoscopy, portal vein embolization) came into everyday application meantime several researches were completed enabling oncological aspect interpretation. Laparoscopy is a proven rational way of approach not only in cases of primary but metastatic liver tumors too: short and long term survival rates and oncological results are comparable with the results of open surgery. Although reports on large number series have not yet been published, it seems that practice of laparoscopy can bring increased number of cases where resection of primary tumor and synchronous liver metastasis can be performed simultaneously. Treatment strategies including surgical procedure overwhelm results of schemes planned with chemotherapy lines only even for patients suffering from advanced metastatic disease with necessary extended liver resection together with major vessel resection or for those who require liver resection following portal occlusion method. Consent opinion in best therapeutic option by oncologist and surgeon is essential to reach optimal liver metastasis patient treatment.