Expanding the role of surgical therapy for colorectal liver metastases

Management of patients with colorectal metastases to the liver often requires complex multidisciplinary care. Improved short-term and long-term outcomes with hepatic resection have resulted in an increasing aggressive surgical approach for many of these patients. Even with more contemporary definition of resectability, however, most patients may not be initial candidates for resection. The use of other preoperative systemic and liver-directed therapies offers the opportunity to expand the number of patients who may be candidates for curative-intent strategies. Systemic therapies can achieve responses which are capable of downsizing unresectable disease to a resectable status. Local therapies can also be used in a similar way. Yet, the optimal application and timing of these multimodality approaches to expand the role of surgical therapy remain controversial.