The current role of liver surgery in the treatment of colorectal liver metastases

Since the establishment of a survival benefit for patients with colorectal cancer liver metastases (CRLM) undergoing liver resection, perioperative outcome has continuously improved, and surgery for CRLM is currently offered with a mortality below 1% in specialized centers (1). Following this development, liver surgery is considered the main curative treatment option for CRLM by most experts, and thus, the indications for surgery of CRLM are continuously extended. These extensions of surgical indications have been based on (I) increasing efficacy of systemic chemotherapy, (II) technical improvements of liver surgery and (III) the expanding knowledge of liver regeneration. Several modern surgical concepts such as repeat or staged resections and portal vein manipulations are based on the unique potential of the liver to regenerate its volume after tissue loss or damage.