The evolution of liver-directed treatments for hepatic colorectal metastases.

The liver is the most common site of metastases from colorectal cancer. Over the past 3 decades, surgical resection has proved to be the most effective and potentially curative therapy for such metastases. This article will review the current practice of hepatic resection for colorectal liver metastases, including the possibility of combined resection of hepatic metastases at the time of resection of the primary cancer. Effective use of neoadjuvant and adjuvant chemotherapy has further expanded the pool of treatable patients. Most recently, ablative therapies based on needle-delivered thermoablation or radiation therapy have become additional weapons for effective treatment. The relative roles and combined use of these local therapies will be highlighted in this article. Overall, the recent combined advances in surgery, radiation therapy, ablative therapy, and chemotherapy have provided more patients with a chance for long-term survival.