Pushing the Limits of Surgical Resection in Colorectal Liver Metastasis: How Far Can We Go?

SIMPLE SUMMARY: Colorectal cancer is the third most common cancer worldwide, and approximately half of all diagnosed patients will develop liver metastases. The only curative option for colorectal liver metastases is resection. Over the last decades, liver resection for colorectal metastases has been in constant evolution, and the limits of what is considered possible are continuously being pushed forward, benefiting many patients. This article sought to review the advances in the field of colorectal liver metastasis surgery and serves as a source of information for surgeons and physicians who wish to learn about all the possibilities in store for patients with colorectal liver metastases. ABSTRACT: Colorectal cancer is the third most common cancer worldwide, and up to 50% of all patients diagnosed will develop metastatic disease. Management of colorectal liver metastases (CRLM) has been constantly improving, aided by newer and more effective chemotherapy agents and the use of multidisciplinary teams. However, the only curative treatment remains surgical resection of the CRLM. Although survival for surgically resected patients has shown modest improvement, this is mostly because of the fact that what is constantly evolving is the indication for resection. Surgeons are constantly pushing the limits of what is considered resectable or not, thus enhancing and enlarging the pool of patients who can be potentially benefited and even cured with aggressive surgical procedures. There are a variety of procedures that have been developed, which range from procedures to stimulate hepatic growth, such as portal vein embolization, two-staged hepatectomy, or the association of both, to technically challenging procedures such as simultaneous approaches for synchronous metastasis, ex-vivo or in-situ perfusion with total vascular exclusion, or even liver transplant. This article reviewed the major breakthroughs in liver surgery for CRLM, showing how much has changed and what has been achieved in the field of CRLM.