Surgery remains the only curative therapy for patients with liver metastases from colorectal cancer. Unfortunately, only a minority of patients are candidates. The use of clinical prognostic indicators and computer programs, such as OncoSurge, may help to identify optimal candidates. Neoadjuvant chemotherapy may render previously ineligible patient candidates for curative surgery after downsizing. Neoadjuvant chemotherapy is associated with histopathologic changes of the liver, and the effect of such changes on survival is unclear. Promising results have been seen with chemotherapy infused through the hepatic artery in conjunction with systemic chemotherapy in the neoadjuvant and adjuvant settings. Adjuvant therapy with oxaliplatin- or irinotecan-based regimens after resection of liver metastases is generally recommended. Individuals should be encouraged to participate in clinical trials to help clarify the role and optimal sequencing of systemic chemotherapy, targeted agents, local therapies, and surgery for patients with hepatic metastases from colorectal cancer.
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