Liver-limited resectable stage IV: Current reality and future perspectives

With refinements in patient selection criteria and surgical techniques, as well as with implementation of a multimodal approach, liver resection permits to obtain 5-year overall survival rates of 50–58%. Improvements in long-term survival have been obtained despite a dramatic change in the definition of resectability to include a number of patients once deemed unresectable. Contemporary criteria used to define resectability are simple. Liver metastases are defined as resectable if: all lesions can be technically resected, with a negative margin, leaving an adequate liver remnant. High-quality imaging is essential to determine resectability. MRI with liver-specific contrast agents should routinely be considered in patients with multiple or small lesion and to restage patients after chemotherapy. Response to chemotherapy is emerging as one of the most powerful prognostic factors. Hepatobiliary surgeons and medical oncologists should work together to evaluate patients with colorectal liver metastases to individualize treatment strategies and maximize the chances of long-term survival.