Controversies in advanced disease – surgical approaches for metastatic resection

Colorectal cancer still remains one of the most common causes of cancer-related deaths in the United States. Approximately 50% of colorectal cancer patients will develop liver metastases and surgical resection is the most effective treatment. This highlights the importance of understanding surgical approaches to metastatic liver disease, which have evolved to include adjunctive procedures such as portal vein embolization and radiofrequency ablation, increasing the number of patients eligible for potentially curative surgical management. Innovations in treatment sequencing, such as perioperative chemotherapy and the liver-first approach to managing synchronous liver metastases, have also improved survival for these patients. These adaptations in surgical management come with new risks, such as chemotherapy-induced liver damage.