Liver Metastasis: Current Concepts in Management and Future Perspectives

Liver metastasis can be defined as the seeding of a malignant tumour from other organs affected by cancer. About half of the patients with colorectal cancer develop liver metastases during the progressive course of the disease. Surgery is the only curative treatment for patients with metastatic liver disease, and the five-year survival rate after resection of all detectable liver metastases can be as high as 40%. Unfortunately, only 25% of patients with liver metastases are candidates for liver resection. Regional treatments such as radiofrequency ablation and cryotherapy may be offered to patients with isolated, unresectable metastases but no evidence of extrahepatic disease. Chemotherapy and chemoembolization are often used in patients with liver metastases, but patients with extrahepatic disease are not suitable candidates for regional ablation. For patients with metastatic colorectal cancer beyond the liver, systemic chemotherapy is a better treatment option. Immunotherapy, when used with chemotherapeutic agents, has an additive therapeutic effect. More than half of the patients die of metastatic liver disease. Surgical resection of distant metastases can lead to prolonged survival and cure in a selected group of patients. This article reviews the current concepts along with recent advances and future perspectives in the management of patients with liver metastasis.