There has been a remarkable resurgence of interest recently in the treatment of liver metastases. The reasons for this are twofold. Firstly, improved pre-operative assessment has enabled more careful patient selection and hence better results have been achieved from resectional surgery, and secondly, better understanding of the blood supply to liver tumours has resulted in techniques designed either to devascularize or to deliver high concentrations of cytotoxic drugs selectively to the tumour. Unfortunately in the main, these newer techniques have been introduced with tremendous enthusiasm but insufficient assessment. This has resulted in confusion and frustration for both patients and doctors alike.
Those patients unfortunate enough to develop colorectal liver metastases, either solitary or multiple, are, in the vast majority of cases incurable and one must be most careful not to institute treatment which may be at best palliative, if significant distress from side-effects overshadows any possible palliation'. Nevertheless, important recent reports chiefly from the USA have necessitated a re-thinking of attitudes towards this common problem. This review is intended as a critical assessment of the methods available to treat liver metastases, paying particular attention to those arising from cancer of the large bowel.
- The general condition of the patient. 2. The extent of metastatic involvement of the liver. 3. The presence of absence of extrahepatic tumour.