Strategies in the multidisciplinary management of synchronous colorectal cancer and resectable liver metastases

Long-term survival following resection of colorectal cancer liver metastases supports hepatic resection as the standard of care for selected metastatic colorectal cancer patients. Many patients will relapse following oncologic resection, and this is usually predictable on the basis of validated factors that separate those most likely and those least likely to benefit from surgery. Yet, some have suggested, perhaps self-servingly, that focus should shift from cure to control, measured in quantity and quality of life gained, and the field has become marred with evidence supporting myriad management strategies. There is no evidence that palliative-intent liver resection is useful, so focus should remain on curative-intent surgery. The patient who presents with synchronous colorectal cancer liver metastases is especially challenging, with issues of location and symptoms of the primary tumor and resectability of hepatic disease at the time of diagnosis, and there is controversy regarding treatment owing to the paucity of evidence-based guidelines. In this review, we describe our approaches to the multidisciplinary treatment of patients with resectable, synchronous disease, including staging, type and timing of chemotherapy, colorectal surgery, hepatobiliary surgery, and adjunctive modalities.