Selection of the optimal surgical and interventional therapies for advanced colorectal cancer liver metastases(CRLM) requires multidisciplinary discussion of treatment strategies early in the trajectory of theindividual patient's care. This paper reports on expert consensus on locoregional and interventionaltherapies for the treatment of advanced CRLM. Resection remains the reference treatment for patientswith bilateral CRLM and synchronous presentation of primary and metastatic cancer. Patients witholigonodular bilateral CRLM may be candidates for one-stage multiple segmentectomies; two-stageresection with or without portal vein embolization may allow complete resection in patients with moreadvanced disease. After downsizing with preoperative systemic and/or regional therapy, curative-intenthepatectomy requires resection of all initial and currently known sites of disease; debulking proceduresare not recommended. Many patients with synchronous primary disease and CRLM can safely undergosimultaneous resection of all disease. Staged resections should be considered for patients in whom thevolume of the future liver remnant is anticipated to be marginal or inadequate, who have significantmedical comorbid condition(s), or in whom extensive resections are required for the primary cancerand/or CRLM. Priority for liver-first or primary-first resection should depend on primary tumour-relatedsymptoms or concern for the progression of marginally resectable CRLM during treatment of the primarydisease. Chemotherapy delivered by hepatic arterial infusion represents a valid option in patients withliver-only disease, although it is best delivered in experienced centres. Ablation strategies are notrecommended as first-line treatments for resectable CRLM alone or in combination with resectionbecause of high local failure rates and limitations related to tumour size, multiplicity and intrahepaticlocation.
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