A Contemporary Review of Resectability and Treatment Strategies for Colorectal Liver Metastases: Part 2-Advanced Surgical Techniques, Conversion Strategies, and the Expanding Boundaries of Treatment.
4 affiliations
- 1Cancer Research Program, Research Institute of the McGill University Health Center (RI-MUHC), Montreal, QC H4A 3J1, Canada.
- 2Department of Surgery, McGill University Health Center, Montreal, QC H4A 0B1, Canada.
- 3Henri-Bismuth Hepatobiliary Center, Paul-Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, 94800 Villejuif, France.
- 4Gerald Bronfman Department of Oncology, McGill University Health Center, Montreal, QC H4A 0B1, Canada.
Abstract
Background/Objectives: Most patients with colorectal liver metastases (CRLM) present with disease beyond upfront technical resectability. Advances in systemic therapy, surgical technique, and liver-directed therapies have expanded the proportion of patients who can achieve curative-intent treatment, yet substantial heterogeneity in practice persists. This review provides a structured synthesis of current management strategies for borderline resectable, initially unresectable, and never resectable CRLM. Methods: A structured literature search of PubMed/MEDLINE, Embase, Scopus and the Cochrane Library was performed to identify studies published between 2000 and 2026 using the eligibility criteria described in Part 1 of this review. Findings were synthesized narratively across systemic, surgical, and liver-directed treatment strategies. Results: Future liver remnant augmentation through regenerative procedures offers higher rates of conversion to resection in borderline cases. Conversion chemotherapy enables secondary resection in 12-35% of initially unresectable patients, with regimen selection guided by RAS/BRAF status, primary tumor sidedness, and performance status; however, most pivotal trials were designed for the broader metastatic colorectal cancer population, with conversion to resection rarely serving as the primary endpoint. For never resectable liver-only disease, liver transplantation demonstrates survival advantage in highly selected patients and iterative local therapy remains an area of active investigation. Across all settings, achieving complete local treatment remains the strongest determinant of long-term survival. Conclusions: Management of complex CRLM requires individualized, multidisciplinary decision-making with repeated reassessment of resectability throughout treatment. The evidence is constrained by heterogeneous resectability definitions, reliance on trials not designed for CRLM-specific endpoints, and limited data on several emerging strategies. Standardized eligibility frameworks and CRLM-specific trial designs are needed to advance the field.
Related
- A Contemporary Review of Resectability and Treatment Strategies for Colorectal Liver Metastases: Part 1—Diagnosis, Defining Resectability, and Management of Upfront Resectable and Synchronous Disease
- Liver transplantation changes the rules for colorectal liver metastases
- Solitary bilateral adrenal metastases from colorectal cancer.
- Comparative efficacy of common adjuvant treatments after resection of colorectal liver metastases : A systematic review and network meta-analysis
- Advances in the Management of Colorectal Liver Metastases: 2026 SSAT–SSO Joint Expert Symposium at Digestive Disease Week
BibTeX
@article{kalil2026contemporary,
title = {{A Contemporary Review of Resectability and Treatment Strategies for Colorectal Liver Metastases: Part 2-Advanced Surgical Techniques, Conversion Strategies, and the Expanding Boundaries of Treatment.}},
author = {Jennifer A Kalil and René Adam and Nicholas Meti and Peter Metrakos},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18193169},
url = {https://europepmc.org/article/MED/42882865},
note = {CC BY},
}
RIS
TY - JOUR
TI - A Contemporary Review of Resectability and Treatment Strategies for Colorectal Liver Metastases: Part 2-Advanced Surgical Techniques, Conversion Strategies, and the Expanding Boundaries of Treatment.
AU - Jennifer A Kalil
AU - René Adam
AU - Nicholas Meti
AU - Peter Metrakos
PY - 2026
DA - 2026/10/01
JO - Cancers
DO - 10.3390/cancers18193169
UR - https://europepmc.org/article/MED/42882865
AB - Background/Objectives: Most patients with colorectal liver metastases (CRLM) present with disease beyond upfront technical resectability. Advances in systemic therapy, surgical technique, and liver-directed therapies have expanded the proportion of patients who can achieve curative-intent treatment, yet substantial heterogeneity in practice persists. This review provides a structured synthesis of current management strategies for borderline resectable, initially unresectable, and never resectable CRLM. Methods: A structured literature search of PubMed/MEDLINE, Embase, Scopus and the Cochrane Library was performed to identify studies published between 2000 and 2026 using the eligibility criteria described in Part 1 of this review. Findings were synthesized narratively across systemic, surgical, and liver-directed treatment strategies. Results: Future liver remnant augmentation through regenerative procedures offers higher rates of conversion to resection in borderline cases. Conversion chemotherapy enables secondary resection in 12-35% of initially unresectable patients, with regimen selection guided by RAS/BRAF status, primary tumor sidedness, and performance status; however, most pivotal trials were designed for the broader metastatic colorectal cancer population, with conversion to resection rarely serving as the primary endpoint. For never resectable liver-only disease, liver transplantation demonstrates survival advantage in highly selected patients and iterative local therapy remains an area of active investigation. Across all settings, achieving complete local treatment remains the strongest determinant of long-term survival. Conclusions: Management of complex CRLM requires individualized, multidisciplinary decision-making with repeated reassessment of resectability throughout treatment. The evidence is constrained by heterogeneous resectability definitions, reliance on trials not designed for CRLM-specific endpoints, and limited data on several emerging strategies. Standardized eligibility frameworks and CRLM-specific trial designs are needed to advance the field.
SN - 2072-6694
ER -