Dhir and Sasson have well-written and offered a thorough introduction to the modern treatment of resectable colorectal liver metastases. Historical aspects of the treatment of colorectal liver metastases are interesting. Studies on the natural history of untreated colorectal liver metastases have reported a 5-year overall survival of 0% regardless of the extent of liver involvement at the time point of diagnosis.
The current guidelines in metastatic colorectal cancer are based on randomized trials. The survival benefit of liver resection may be even greater than that of the oncologic treatment, and one may achieve a cure in 20% or more. The resectability rate of patients with colorectal liver metastases improved from 0% to nearly 25%, and the 5-year OS rate in these patients has improved from 0% to more than 50%.
The most significant impact of the modern treatment of resectable colorectal liver metastases may not be improved surgery or improved chemotherapy and targeted therapy but adopting a multidisciplinary treatment approach.
Dhir and Sasson suggested traditional predictors of survival that may be replaced by factors that are more relevant in the modern series of patients undergoing perioperative chemotherapy. In several recent reports, KRAS mutations are common and have proven to have an impact on survival in patients with resectable colorectal liver metastases.
Today, liver resection is considered safe, with reported mortality and morbidity in the range of 1-3% and 15-30%, respectively. Expanding the option of resection to an increasing number of patients with colorectal liver metastases is based on improved surgical techniques and selection, promising liver-directed interventional modalities, and improved oncologic treatment.