Optimal Timing for Surgical Treatment of Colorectal Liver Metastases

Metachronous CRCLM should be evaluated by multidisciplinary oncologic consilium. Diagnostic evaluation must be completed by dinamic CT or MR of the liver. In the case of a small number of metastases, operation could be performed immediately. In such cases, neoadjuvant therapy could be recomended because of decreasing recurrence rates, slight increase of the overall survival rate and to evaluate malignant potential. Neoadjuvant therapy is mandatory in cases with >4 metastases and potentialy resectable metastases, due to possibility to convert 25% of them to secondary resectable category. In the case of incidentaly discovered metastases (during the primary colorectal operation), the removal of primary tumor should not be abandoned. Biopsy of metastatic lesion is not recomended. Complications of CRC should be treated by palliative procedures /stoma, palliative resection, interventional endoscopy or radiology) followed by consiliary multidisciplinary teratment and liver surgery in the second operative act. Asymptomatic T 1,2, N 0,1 primary tumors of the right colon could be treated by simultaneous major liver resection. Left colonic and rectal resection could be safe combined with minor liver resection (up to 2 liver segments). In the cases of T 3,4, N 1,2 CRC with synchronous liver metastases neoadjuvant therapy is mandatory, as in the cases of multiple (>4) metastases. Reverse strategy could be effective in these cases. Acta Medica Medianae 2015;54(1): 87-96.