Resection of Liver Metastases: State of the Art

In this article, Ravikumar and Gallos nicely summarize the current understanding of liver resection for metastases. My comments here will be limited to resection of colorectal metastases, as this is the most common and best characterized of the procedures described.

The efficacy of resection for colorectal metastases relates to both the ability to undertake this approach safely and the biological features of colorectal cancer. However, of equal if not greater importance is the lack of an effective nonsurgical approach.

Historical Perspective

The 1980s were the turning point that took liver resection from a sporadically performed oddity into the mainstream of standard clinical care. A short historical perspective might be useful here.

Up until the 1980s, the legitimacy of liver resection for colorectal metastases was still open to question. Until then, most physicians believed that liver resection had an extremely high morbidity and mortality, that resection of metastatic cancer could not be curative, and that even if the liver resection succeeded, it succeeded for only a single metastasis, but never for more than one. It turned out that all these beliefs were inaccurate.

The mortality associated with liver resection before the 1980s often approached 30%,[1] which discouraged most nonsurgeons from referring patients for this procedure. However, by the 1980s, mortality in most series was well below 5%.[1] This significant drop was caused by many factors, including, but not limited to (1) improved surgical technique and intraoperative support, (2) a better understanding of liver anatomy, and (3) improved technologies such as the ultrasonic dissector, the argon-beam coagulator, and intraoperative ultrasound.

Unique Biology