title: Multimodal management of colorectal liver metastases and the effect on regeneration and outcome after liver resection.
abstract: Management of colorectal liver metastases (CRLM) has dramatically changed during the last decade and has now become more multimodal and aggressive, including the use of downstaging chemotherapy, portal vein embolization to increase the function of the liver remnant or both in combination. Radiofrequency ablation is also an option in CRLM, potentially combined with surgical resection. Results are quite convincing concerning the safety of liver resection also when performed following neoadjuvant chemotherapy. Sparing liver parenchyma in patients with bilobar liver metastatic disease subjected to liver resection may be possible without endangering surgical radicality. Sparing liver parenchyma when using neoadjuvant chemotherapy, a chemotherapy-free period of 6 weeks or more seems to positively affect liver regeneration. There is still the possibility to reresect recurrent liver lesions, though there seems to be a tendency toward fewer reresections following the use of adjuvant chemotherapy.
authors.affiliation: Department of Surgery, Clinical Sciences Lund, Skåne University Hospital and Lund University, Lund, Sweden.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ansari
authors.forename: Magnus
authors.initials: M
authors.lastname: Bergenfeldt
authors.forename: Bobby
authors.initials: B
authors.lastname: Tingstedt
authors.forename: Roland
authors.initials: R
authors.lastname: Andersson
mesh_terms: D017115:Catheter Ablation; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D004621:Embolization, Therapeutic; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000502:physiology*; D008113:Liver Neoplasms / Q000503:physiopathology / Q000556:secondary / Q000628:therapy*; D020360:Neoadjuvant Therapy; D059351:Organ Sparing Treatments; D012038:Regeneration