Multimodal treatment of colorectal liver metastases: Where are we? Current strategies and future perspectives

Abstract

Despite the continued high prevalence of colorectal cancer in the Western world, recent years have witnessed a decline in its mortality rate, largely attributable to the sustained advancement of multimodal treatment modalities for metastatic patients. One persisting issue is lack of consensus between different centres and multidisciplinary teams regarding definition of resectability, the duration of chemotherapy treatment, and surgical strategy. This narrative review outlines current multimodal treatment of patients with colon cancer metastatic to the liver and/or lung in different clinical scenarios. Currently, there are multiple multimodal strategies that can be employed to enhance resectability in these patients. These include novel and sophisticated target therapies (such as novel immunotherapeutic modalities and micro RNAs), complex resections utilising parenchyma-sparing techniques, liver transplantation, and cytoreductive strategies in patients for whom a curative option is not feasible. It is the responsibility of the scientific community to establish standardised protocols across different centres, based on the most recent evidence, while maintaining a high degree of personalisation of treatment for each individual patient. It seems likely that artificial intelligence (AI) will play a significant role in achieving this goal.