Treatment Options for Resectable Colorectal Liver Metastases in the Presence of Extrahepatic Disease

Traditionally, extrahepatic disease (EHD) was considered a contraindication to resection of colorectal liver metastases (LM) (Scheele et al. Surgery. 110(1):13–29, 1991; Fong et al. J Clin Oncol. 15(3):938–46, 1997). Nevertheless, widespread improvement in surgical morbidity and mortality, as well as improved efficacy of chemotherapeutic agents, has driven increased interest in surgical metastasectomy with the intent of improved survival and potential cure (Elias et al. Ann Surg Oncol. 11(3):274–80, 2004; Elias et al. Br J Surg. 90(5):567–74, 2003). In patients that undergo complete resection of LM and EHD, recurrence is expected 80–95% of the time (Pulitano et al. Ann Surg Oncol. 18:1380–8, 2011; Leung et al. Ann Surg. 265:158–65, 2017; Rajakannu et al. Clin Colorectal Cancer. 17(1):41–9, 2018; Carpizo et al. Ann Surg Oncol. 16:2138–46, 2009). Therefore, recurrence is the norm, and care must be taken to select patients who are most likely to benefit from surgical resection. However, recent evidence has shown that long-term survival is possible in selected patients with resected LM and EHD.