Clin Colon Rectal Surg 2024; 37(02): 080-084
DOI: 10.1055/s-0042-1758822
Review Article

Surgical and Interventional Management of Liver Metastasis

Edwin R. Itenberg
1   Division of Colon and Rectal Surgery, Henry Ford Hospital, Detroit, Michigan
Ana M. Lozano
2   Department of General Surgery, Henry Ford Macomb Hospital, Clinton Township, Michigan
› Institutsangaben


Colorectal cancer is one of the most common cancers diagnosed worldwide. While the incidence of colorectal cancer has been declining since the adoption of screening colonoscopy, the findings of liver metastasis are still found in up to 25% of patients at diagnosis. The management of liver metastasis has evolved over the past two to three decades, and survival rates have improved secondary to improved systemic therapy, surgical options, and local therapies. In this article, we aim to review the available surgical and ablative options for management of colorectal liver metastasis, as well as appropriate imaging and patient selection.


Artikel online veröffentlicht:
09. Dezember 2022

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  • References

  • 1 Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. [published correction appears in CA Cancer J Clin. 2021 Jul;71(4):359] CA Cancer J Clin 2021; 71 (01) 7-33
  • 2 Miller CL, Taylor MS, Qadan M. et al. Prognostic significance of surgical margin size after neoadjuvant FOLFOX and/or FOLFIRI for colorectal liver metastases. J Gastrointest Surg 2017; 21 (11) 1831-1840
  • 3 Dörr NM, Bartels M, Morgul MH. Current treatment of colorectal liver metastasis as a chronic disease. Anticancer Res 2020; 40 (01) 1-7
  • 4 Jacobson RA, Bhama AR. Evaluation and management of colorectal cancer hepatic metastases. Dis Colon Rectum 2021; 64 (07) 777-780
  • 5 National Comprehensive Cancer Network. 2022 NCCN Clinical Practice Guidelines in Oncology Colon Cancer Version 1. 2022. [online] Accessed November 4, 2022 at:
  • 6 National Comprehensive Cancer Network. 2022 NCCN Clinical Practice Guidelines in Oncology Rectal Cancer Version 1. 2022. [online]. Accessed November 4, 2022 at:
  • 7 Renzulli M, Clemente A, Ierardi AM. et al. Imaging of colorectal liver metastases: new developments and pending issues. Cancers (Basel) 2020; 12 (01) 151
  • 8 Kawaguchi Y, Vauthey J-N. The landmark series: randomized control trials examining perioperative chemotherapy and postoperative adjuvant chemotherapy for resectable colorectal liver metastasis. Ann Surg Oncol 2020; 27 (11) 4263-4270
  • 9 Nordlinger B, Sorbye H, Glimelius B. et al; EORTC Gastro-Intestinal Tract Cancer Group, Cancer Research UK, Arbeitsgruppe Lebermetastasen und-tumoren in der Chirurgischen Arbeitsgemeinschaft Onkologie (ALM-CAO), Australasian Gastro-Intestinal Trials Group (AGITG), Fédération Francophone de Cancérologie Digestive (FFCD). Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet 2008; 371 (9617): 1007-1016
  • 10 Kow AWC. Hepatic metastasis from colorectal cancer. J Gastrointest Oncol 2019; 10 (06) 1274-1298
  • 11 Aloia TA, Vauthey JN, Loyer EM. et al. Solitary colorectal liver metastasis: resection determines outcome. Arch Surg 2006; 141 (05) 460-466 , discussion 466–467
  • 12 Kanas GP, Taylor A, Primrose JN. et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol 2012; 4: 283-301
  • 13 Adam R, De Gramont A, Figueras J. et al; Jean-Nicolas Vauthey of the EGOSLIM (Expert Group on OncoSurgery management of LIver Metastases) group. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist 2012; 17 (10) 1225-1239
  • 14 Cillo U, Fondevila C, Donadon M. et al. Surgery for cholangiocarcinoma. Liver Int 2019; 39 (suppl 1): 143-155
  • 15 Fichtinger RS, Aldrighetti L, Troisi R. et al. 384o laparoscopic versus open hemihepatectomy: the Orange II Plus Multicenter Randomized Controlled trial. Ann Oncol 2021; 32
  • 16 Adam R, de Gramont A, Figueras J. et al; of the EGOSLIM (Expert Group on OncoSurgery management of LIver Metastases) group. Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev 2015; 41 (09) 729-741
  • 17 Abelson JS, Michelassi F, Sun T. et al. Simultaneous resection for synchronous colorectal liver metastasis: the new standard of care?. J Gastrointest Surg 2017; 21 (06) 975-982
  • 18 Martin R, Paty P, Fong Y. et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 2003; 197 (02) 233-241 , discussion 241–242
  • 19 Mohammad WM, Balaa FK. Surgical management of colorectal liver metastases. Clin Colon Rectal Surg 2009; 22 (04) 225-232
  • 20 Giuliante F, Viganò L, De Rose AM. et al. Liver-first approach for synchronous colorectal metastases: analysis of 7360 patients from the livermetsurvey registry. Ann Surg Oncol 2021; 28 (13) 8198-8208
  • 21 Bahadoer RR, Dijkstra EA, van Etten B. et al; RAPIDO collaborative investigators. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. [published correction appears in Lancet Oncol. 2021 Feb;22(2):e42] Lancet Oncol 2021; 22 (01) 29-42
  • 22 Cirocchi R, Trastulli S, Boselli C. et al. Radiofrequency ablation in the treatment of liver metastases from colorectal cancer. Cochrane Database Syst Rev 2012; 13 (06) CD006317
  • 23 Schlick CJR, Merkow RP, Bentrem DJ. Nonresectional regional therapies for metastatic colorectal cancer to the liver. J Surg Oncol 2019; 119 (05) 636-641
  • 24 Wong SL, Mangu PB, Choti MA. et al. American Society of Clinical Oncology 2009 clinical evidence review on radiofrequency ablation of hepatic metastases from colorectal cancer. J Clin Oncol 2010; 28 (03) 493-508
  • 25 Wang CZ, Yan GX, Xin H, Liu ZY. Oncological outcomes and predictors of radiofrequency ablation of colorectal cancer liver metastases. World J Gastrointest Oncol 2020; 12 (09) 1044-1055
  • 26 Lu DS, Raman SS, Limanond P. et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 2003; 14 (10) 1267-1274
  • 27 Knott EA, Ziemlewicz TJ, Lubner SJ. et al. Microwave ablation for colorectal cancer metastasis to the liver: a single-center retrospective analysis. J Gastrointest Oncol 2021; 12 (04) 1454-1469
  • 28 Shibata T, Niinobu T, Ogata N, Takami M. Microwave coagulation therapy for multiple hepatic metastases from colorectal carcinoma. Cancer 2000; 89 (02) 276-284
  • 29 Martin J, Petrillo A, Smyth EC. et al. Colorectal liver metastases: Current management and future perspectives. World J Clin Oncol 2020; 11 (10) 761-808
  • 30 Sabanathan D, Eslick GD, Shannon J. Use of neoadjuvant chemotherapy plus molecular targeted therapy in colorectal liver metastases: a systematic review and meta-analysis. Clin Colorectal Cancer 2016; 15 (04) e141-e147
  • 31 Gruenberger T, Bridgewater J, Chau I. et al. Bevacizumab plus mFOLFOX-6 or FOLFOXIRI in patients with initially unresectable liver metastases from colorectal cancer: the OLIVIA multinational randomised phase II trial. Ann Oncol 2015; 26 (04) 702-708
  • 32 Schwartzberg LS, Rivera F, Karthaus M, Fasola G, Canon JL, Hecht JR, Yu H, Oliner KS, Go WY. Peak: A randomized, Multicenter Phase II study of panitumumab plus modified fluorouracil, leucovorin, and Oxaliplatin (MFOLFOX6) or bevacizumab plus MFOLFOX6 in patients with previously untreated, unresectable, wild-type kras exon 2 metastatic colorectal cancer. Journal of Clinical Oncology 2014; 32 (21) 2240-2247