Scandinavian Journal of Gastroenterology. 2012; 47: 1460–1466 ORIGINAL ARTICLE Multimodal management of colorectal liver metastases and the effect on regeneration and outcome after liver resection DANIEL ANSARI, MAGNUS BERGENFELDT, BOBBY TINGSTEDT & ROLAND ANDERSSON Department of Surgery, Clinical Sciences Lund, Skåne University Hospital and Lund University, Lund, Sweden 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. Key Words: colorectal cancer, improved outcome, liver metastases, multimodal treatment, regeneration Introduction Colorectal cancer is, at least in the Western world, a frequent condition. The yearly incidence of colorectal cancer is estimated at 56 per 100,000 inhabitants, thus representing the third cause of cancer-related mortality in the Western world [1]. It has been stated that 50–60% of colorectal cancer patients will develop metastases and if surgically resectable, colorectal liver metastases (CRLM) have a better prognosis than if left untreated. Historically, the median survival of CRLM has been less than 6 months [2]; 10–20% of patients have liver metastases without extrahepatic spread and thus represent potential candidates for curative resection with reported survival rates in the range of 40–60% [3,4]. During the last decade, the management of CRLM has developed dramatically with introduction of novel ways of intervention, and a substantial increase in survival and quality of life. New techniques have included portal vein embolization (PVE) in order to increase the remnant part of the liver following liver resection, neoadjuvant chemotherapy in order to downsize the tumor, or a combination of these two techniques. Also, the use of radiofrequency ablation (RFA), alone or together with liver resection, has evolved as a therapeutic option. To be discussed is also whether to use limited liver resections or exten- sive liver resection for bilobar CRLM, in order to spare liver parenchyma. Incomplete knowledge exists concerning the use of neoadjuvant chemotherapy in relation to both intra- and postoperative complica- tions, as well as the effects on volumetric liver regen- eration following liver resection. Further, the optimal time interval between chemotherapy and resection needs to be defined. Despite better overall survival, most patients will suffer a liver recurrence, and some 10–20% may be candidates for reresections. The present review aims at an overview of current standards in the multimodal treatment of CRLM Correspondence: Roland Andersson, MD PhD, Department of Surgery, Clinical Sciences Lund, Skåne University Hospital and Lund University, SE-221 85 Lund, Sweden. Tel: +46 46 17 23 59. E-mail: roland.andersson@med.lu.se (Received 18 June 2012; revised 16 August 2012; accepted 27 August 2012) ISSN 0036-5521 print/ISSN 1502-7708 online Ó 2012 Informa Healthcare DOI: 10.3109/00365521.2012.729083