Originally published as JCO Early Release 10.1200/JCO.2004.00.6155 on October 17 2005

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Extending the Frontiers of Surgical Therapy for Hepatic Colorectal Metastases: Is There a Limit?

From the Division of Surgical Oncology, University of California, Davis Cancer Center, Sacramento, CA; Helen F. Graham Cancer Center, Newark Department of Hepatobiliary and Digestive Surgery, Newark, DE: Beaujon Hospital, Paris VII University, Clichy, France

Address reprint requests to Vijay P. Khatri, MD, FACS, University of California, Davis Cancer Center, 4501 X Street, Suite 3010, Sacramento, CA 95817; e-mail: vijay.khatri{at}ucdmc.ucdavis.edu

Hepatic resection for colorectal metastases, limited to the liver, has become the standard of care, and currently remains the only potentially curative therapy. Numerous single institutional reports have demonstrated long-term survival, and there are no other treatment options that have shown a survival plateau. However, curative resection is possible in less than 25% of patients with disease limited to the liver, which consequently translates into only 5% to 10% of the original group developing colorectal cancer. To increase the number of patients who could benefit from hepatic resection, the last decade has seen considerable effort directed towards the following areas, (1) refining prognostic factors that would improve patient selection, (2) advancements in surgical technique such as, use of intraoperative ultrasonography, controlling hemorrhage through use of vascular clamping techniques supplemented with low central venous pressure anesthesia, availability of novel devices for parenchymal transection, and controlled anatomic hepatectomy with Glissonian technique, and (3) novel approaches to permit curative hepatic resection such as, preoperative portal vein embolization for hypertrophy of future liver remnant and staged hepatic resection. This article reviews development of these innovative multidisciplinary modalities and the aggressive surgical approach that has been adopted to extend the frontiers of surgical therapy for colorectal hepatic metastases.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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