Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2019; 11(2): 150-172
Published online Feb 27, 2019. doi: 10.4254/wjh.v11.i2.150
Colorectal liver metastases: An update on multidisciplinary approach
Felix Che-Lok Chow, Kenneth Siu-Ho Chok
Felix Che-Lok Chow, Department of Surgery, Queen Mary Hospital, Hong Kong, China
Kenneth Siu-Ho Chok, Department of Surgery and State Key Laboratory for Liver Research, the University of Hong Kong, Hong Kong, China
Author contributions: Chok KSH conceptualized and supervised the study; Chow FCL did the literature review and wrote the manuscript; both authors approved the submitted version of manuscript.
Conflict-of-interest statement: None of the authors has any conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Kenneth Siu-Ho Chok, FRCS(Ed), Associate Professor, Department of Surgery and State Key Laboratory for Liver Research, the University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
Telephone: +852-22553025 Fax: +852-28165284
Received: October 5, 2018
Peer-review started: October 6, 2018
First decision: November 15, 2018
Revised: November 24, 2018
Accepted: December 4, 2018
Article in press: December 5, 2018
Published online: February 27, 2019

Liver metastasis is the commonest form of distant metastasis in colorectal cancer. Selection criteria for surgery and liver-directed therapies have recently been extended. However, resectability remains poorly defined. Tumour biology is increasingly recognized as an important prognostic factor; hence molecular profiling has a growing role in risk stratification and management planning. Surgical resection is the only treatment modality for curative intent. The most appropriate surgical approach is yet to be established. The primary cancer and the hepatic metastasis can be removed simultaneously or in a two-step approach; these two strategies have comparable long-term outcomes. For patients with a limited future liver remnant, portal vein embolization, combined ablation and resection, and associating liver partition and portal vein ligation for staged hepatectomy have been advocated, and each has their pros and cons. The role of neoadjuvant and adjuvant chemotherapy is still debated. Targeted biological agents and loco-regional therapies (thermal ablation, intra-arterial chemo- or radio-embolization, and stereotactic radiotherapy) further improve the already favourable results. The recent debate about offering liver transplantation to highly selected patients needs validation from large clinical trials. Evidence-based protocols are missing, and therefore optimal management of hepatic metastasis should be personalized and determined by a multi-disciplinary team.

Keywords: Colorectal cancer, Liver metastases, Hepatic resection, Neoadjuvant therapy, Adjuvant chemotherapy, Intra-arterial therapy, Precision medicine, Multidisciplinary approach

Core tip: Surgery offers the only hope of cure in colorectal liver metastasis. It can be performed if complete metastasectomy is attainable. There is no consensus on the ideal management strategy for synchronous disease. A subset of patients presenting with unresectable disease may become eligible for resection after liver remnant augmentation or conversion therapy (chemo-therapeutics +/- biological agents). Amid increasing application of loco-regional therapies to colorectal liver metastasis, their role in the treatment paradigm remains to be defined. Refined patient selection – with greater emphasis on tumour biology – is essential to improving treatment outcome. The multidisciplinary approach helps determine the optimal treatment strategy from an expanding armamentarium of therapeutic options for each patient.