Recent advances in the curative treatment of colorectal liver metastases.

Liver resection provides the basis for curative treatment of colorectal liver metastases (CLM), achieving 5-year survival rates as high as 58%. Use of this approach is limited by the number of patients whose CLM are resectable at the time of initial presentation and the risk of early recurrence after surgery, justifying development of modern perioperative chemotherapy regimens. Chemotherapy-associated hepatotoxicity led to development of standardized treatment strategies that balance the duration and timing of preoperative chemotherapy to minimize postoperative morbidity. The current challenge in the effort to offer curative treatment for CLM is selection of patients who will most benefit from an aggressive surgical approach. New end points of preoperative chemotherapy such as pathologic response and new radiologic response criteria have been evaluated as predictive factors for survival after liver resection and provide useful support in selecting patients for surgery.