Colorectal liver metastases (CRLMs) are common and can either present at the time of initial colorectal cancer diagnosis (synchronous) or develop subsequently (metachronous). There has been increasing interest in the treatment of CRLMs in recent years due to the development of new therapies and improving prognosis. A key factor in the treatment of CRLMs is the need for detailed discussion of individual patients in a multidisciplinary environment involving specialists with a wide range of interests. Accordingly, a plan of treatment and follow-up can be devised at an early stage. The importance of this approach cannot be overemphasised.


Surgery
Surgery is the most important treatment modality for patients with CRLMs. Appropriate surgery in selected patients will result in longterm survival of up to 40%.^1,2 This percentage has increased over the last two decades. There have been developments in surgical technique, including portal vein embolisation and safer liver division and resection, as well as improvements in post-operative management. As a result, resections are now more extensive and, due to improving expertise, are associated with reduced postoperative morbidity and mortality. A general principle is to resect all macroscopic disease, aiming for a potentially curative resection. In order to achieve this, it may be necessary to combine surgical excision with ablation, e.g. radiofrequency ablation, intra-operatively or percutaneously in the post-operative period. Often this avoids an unacceptably dangerous major resection; for example, an extended right hemi-hepatectomy can be combined with radiofrequency ablation of smaller lesions on the left side of the liver. However, it should be noted that initially only 15–20% of patients are suitable for surgical resection.³ As a result, an attempt to increase the resectability rate with additional treatments has been advocated.

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