Hepatic Resection for Extrahepatic Metastatic Disease: When Is It Reasonable?

The presence of limited and resectable extrahepatic metastases (EHM) in addition to colorectal liver metastases (LM) is no longer a contraindication to surgery. Long-term survival (between 25 and 30 % at 5 years) is possible for highly selected patients. The site of occurrence is a key prognostic factor. Results are best for lung EHM and limited peritoneal metastases (PM), lower when EHM invade the proximal hepatic lymph nodes, and worse for other EHM. Treatment decision making is difficult when faced with an infinite number of possible combinations between the different sites of metastases, their number, and the overall tumor load. General performance status, technical contingency, and chemosensitivity are also important factors to be reckoned with. In the future, a considerable amount of data concerning these patients and new statistical tools will be required to create clear decision trees.