The concept of resectability in the treatment of colorectal cancer liver metastases: the present notion

To treat colorectal cancer liver metastases presents still a challenge and to take tactical decisions requires the participation of a multidisciplinary team of specialists. Despite significant progress in the drug therapy of this disease, the best long-term results can be achieved with hepatectomy. In this connection, one of the key tasks at the present stage is to enhance resectability. The latter is not greater than 10–15% in the 1990s. In the past two decadea, liver resectability for colorectal cancer liver metastases has changed considerably: indications for this operation have been expanded; additional technologies, such as local destruction of foci, have emerged; the concept of preoperative drug therapy has been developed and improved; surgical techniques to stimulate the left liver to grow postresection have been introduced; many problems related to the biological features of a tumor, etc. have been studied. This has made the concept of resectability itself to change from purely technical to complex, involving both technical and oncological components. This change can increase the level of resectability up to 50%. The paper describes the evolution of the concept of resectability in colorectal cancer liver metastases and the present notion accepted at the Consensus Conference of Leading Surgical Hepatologists in 2012.