Colorectal liver metastases: state-of-the-art management and surgical approaches

Background: The liver is the most common site of metastasis for patients with colorectal cancer, and resection is associated with significantly improved survival for selected patients. Advancements in perioperative care, operative technique, and multidisciplinary management have led to improved outcomes for patients with colorectal liver metastases (CLM). Purpose: This review discusses recent advances in perioperative management, patient selection and prognostication, and surgical technique that make up the state-of-the-art management for patients with CLM. Conclusion: Novel approaches to prognostication and measurement of treatment response, such as tumor somatic mutational profiling and circulating tumor DNA (ctDNA), are revolutionary instruments for patient selection and treatment sequence. Further, refinements to surgical approaches for patients with bilateral CLM, including two-stage hepatectomy (TSH), are available for these patients and may lead to improved surgical outcomes. The advances discussed in this review will result in more patients being considered for resection and refined selection for perioperative care strategies that will lead to improved survival for patients with CLM.