Colorectal cancer patients with oligometastatic liver disease: what is the optimal approach?

Although metastatic colorectal cancer is typically incurable, in a good percentage of patients (20% to 50%) who have oligometastatic disease confined to a single organ-usually the liver-complete metastasectomy can result in cure. However, once the decision to pursue surgery is made, there remain a number of issues that must be addressed in order to ensure the best possible outcome. These include whether to perform synchronous or staged resections of the liver metastasis and the primary colon cancer; whether surgery should be performed before, after, or in the absence of chemotherapy; if chemotherapy is used, which agents will be best; and in patients with locally advanced rectal cancer, whether pelvic radiation should be incorporated into the treatment plan. Unfortunately, there are limited data that can provide guidance in deciding these questions in a particular patient. Here we present the insights we have arrived at through our own considerable experience with this patient population, and we reflect on the relevant studies that are available.