title: Controversies in the oncosurgical management of liver limited stage IV colorectal cancer.
abstract: Colorectal cancer is the fourth most common cancer diagnosis in the world (around 1.2 million diagnoses each year), and accounts for the second highest number of deaths. Over half of patients with colorectal cancer will develop liver metastases, with one quarter presenting in stage IV. There is growing evidence that patients with liver-limited disease represent a distinct biological cohort who will benefit from aggressive management. Only a minority of patients are technically resectable, but around 40% of patients with resected liver limited disease are alive 5 years after diagnosis compared with less than 1% for those with disseminated disease. Novel surgical techniques have been developed to allow more patients to undergo resection and there is also growing recognition that the chemotherapeutic manipulation of irresectable disease may bring some patients to resection with good long-term outcome. Perioperative chemotherapy can also improve long-term outcome through improved biological selection and destruction of occult micrometastases. This review outlines current oncosurgical treatment strategies for liver-limited stage IV colorectal cancer, and discusses some of the controversies surround the management of these complex patients.
authors.affiliation: School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool L69 3GA, UK; Northwestern Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK. Electronic address: robjones@liv.ac.uk.
authors.forename: R P
authors.initials: RP
authors.lastname: Jones
authors.affiliation: HPB Service, Paracelsus Medizinische Privatuniversität Universitätsklinik für Chirurgie, Salzburg, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Stättner
authors.affiliation: School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool L69 3GA, UK; Northwestern Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK.
authors.forename: P
authors.initials: P
authors.lastname: Sutton
authors.affiliation: School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool L69 3GA, UK; Northwestern Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK.
authors.forename: D F
authors.initials: DF
authors.lastname: Dunne
authors.affiliation: School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool L69 3GA, UK; Northwestern Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK.
authors.forename: D
authors.initials: D
authors.lastname: McWhirter
authors.affiliation: Northwestern Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK.
authors.forename: S W
authors.initials: SW
authors.lastname: Fenwick
authors.affiliation: Northwestern Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK.
authors.forename: H Z
authors.initials: HZ
authors.lastname: Malik
authors.affiliation: Northwestern Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Poston
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D019317:Evidence-Based Medicine; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D009367:Neoplasm Staging
keywords: Colorectal; Liver; Oligometastases; Oncology; Surgery