Surgery and local treatments of liver metastases from colorectal cancer: how to improve results.

Over the last 30 years, the benefits of surgical resection for liver metastases have been established. Actually, surgical resections are feasible with a very low mortality and a 5-year survival that approaches 40 %. However, even if progresses in surgery and anaesthesiology now render possible extensive resections with removal of large, numerous or bilateral lesions, only 10 to 20 % of patients are candidate to surgery. The others gain benefit from chemotherapy with more and more active drugs. To improve this overall picture, efforts have been made to increase the number of patients that could be candidates for surgery. Shrinkage of tumours after administration of preoperative chemotherapy and availability of ablative techniques now permit to treat with curative intent metastases initially considered as non-resectable.