Controversies in the Management of Liver Metastases

While considerable progress has been made in both surgical treatment of liver metastases and neoadjuvant or postoperative chemotherapy, decision making has become more complex. The definition of accurate measures is very difficult because there exists no consensus regarding pre- or postoperative predictors of survival in patients undergoing liver resection: Even though PET is well established in the diagnosis of colorectal cancer and its metastases, it is unclear whether a combination of imaging modalities will be of additional value. Neoadjuvant strategies are very efficient in downsizing metastasis, but they at the same time reduce functional liver reserve due to chemotherapy-induced liver injury. The advantages and disadvantages of the 'liver first' approach are likewise discussed, as are controversial issues in the use of portal vein embolization and radiofrequency ablation versus resection. Even though the main focus of this publication is on colorectal liver metastases, other primary cancers also receive some attention: Papers on resection of liver metastases combined with primary cancers conclude the discussions. This collection of papers provides valuable information on the many issues connected with the management of liver metastases, both colorectal and non-colorectal. Surgeons confronted with the question as to the best treatment strategy will find it a very helpful aid in their decision process.