| Abstract: |
Resection of colorectal liver metastases (CRLM) improves survival compared with systemic therapy alone. Technical resectability requires preservation of adequate functional liver remnant with biliary drainage, vascular inflow, and outflow. Assessment for resectability should be predicated on high-quality cross-sectional imaging. Systemic therapy often has a role in the treatment of CRLM; sequence of treatment should be discussed in a multidisciplinary setting, particularly in the setting of synchronous disease. The mainstay of treatment for patients with unresectable CRLM is systemic therapy. Strategies to expand resectability include the use of ablation in conjunction with resection, portal vein embolization (PVE), two-stage hepatectomy, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), hepatic artery infusion pump (HAIP) chemotherapy, and liver transplantation. Local ablative strategies (radiofrequency, microwave), and to a lesser extent stereotactic ablative radiotherapy (SABR/SBRT) and irreversible electroporation (IRE), should be considered in patients with otherwise unresectable disease in whom all lesions can be treated. Regional therapies for patients with unresectable CRLM, with varying levels of evidence, include transarterial chemotherapy with irinotecan drug-eluting beads (DEBIRI), selective internal radiotherapy with yttrium-90, and HAIP. Given the increasing options and possible treatment permutations, patients with CRLM should be discussed in a multidisciplinary setting including hepatobiliary surgeons. © Springer Nature Switzerland AG 2020. |
