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Semin Liver Dis 2013; 33(03): 262-272
DOI: 10.1055/s-0033-1351785
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Operative Management of Colorectal Liver Metastases

Gilles Mentha
1   Divisions of Transplantation and Visceral Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
4   Hepato-Pancreato-Biliary Center, University Hospitals of Geneva, Geneva, Switzerland
,
Sylvain Terraz
2   Division of Radiology, Department of Medical Imaging and Information Sciences University Hospitals of Geneva, Geneva, Switzerland
4   Hepato-Pancreato-Biliary Center, University Hospitals of Geneva, Geneva, Switzerland
,
Axel Andres
1   Divisions of Transplantation and Visceral Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
,
Christian Toso
1   Divisions of Transplantation and Visceral Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
4   Hepato-Pancreato-Biliary Center, University Hospitals of Geneva, Geneva, Switzerland
,
Laura Rubbia-Brandt
3   Division of Clinical Pathology, Department of Pathology, University Hospitals of Geneva, Geneva, Switzerland
4   Hepato-Pancreato-Biliary Center, University Hospitals of Geneva, Geneva, Switzerland
,
Pietro Majno
1   Divisions of Transplantation and Visceral Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
4   Hepato-Pancreato-Biliary Center, University Hospitals of Geneva, Geneva, Switzerland
› Author Affiliations
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Publication History

Publication Date:
13 August 2013 (online)

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Abstract

In this review, the authors describe the management of patients with colorectal liver metastases in the era of effective chemotherapies and advanced interventional radiology. They give special attention to the surgical procedures that decrease the operative mortality and morbidity and produce clear margins. They discuss the best timing for chemotherapy, resection of the primary tumor, and resection of the liver metastases in an effort to improve long-term survival. The use of preoperative portal vein embolization, two-stage hepatectomy for bilobar synchronous liver metastases, and the liver-first strategy have allowed for treatment of patients with advanced disease with a curative intent, and to obtain 5-year overall survival of 30 to 60% despite poor prognostic factors and a cure (no recurrence at 10 years) in more than 20% of patients. These rates would have been unimaginable only two decades ago.

Keywords

colorectal liver metastases - operative management - margin - reversed approach - long-term survival