Updated 6 May 2008

Patients with isolated liver metastases should be considered for surgical resection. With advances in surgical management, including multi-stage procedures and selective embolization, in addition to improvements in chemotherapeutic options in the neo-adjuvant setting, cases which previously would have been deemed unresectable may prove operable. Disease free survival rates of up to 50% (usually around 25-30%) have been reported.

Preoperative assessment requires exclusion of extra-hepatic metastases and dual or tri-phasic CT scanning to evaluate the proximity of the liver metastases to intra-hepatic vasculature. PET scanning may also be useful. If liver surgery is contemplated, referral to a centre with hepato-biliary expertise is recommended.

Although resection of isolated lung metastases may confer a similar benefit, the data supporting this is less robust. Consultation with a thoracic surgeon experienced in the management of lung-limited metastatic disease may be helpful.

It is unclear whether patients benefit from "adjuvant" chemotherapy following resection of isolated liver or lung metastases. It is recommended that these patients be referred to a medical oncologist for discussion of the potential risks and benefits of adjuvant therapy.

Non-resectable liver lesions are sometimes appropriate for other local therapies, such as radiofrequency ablation (RFA) or palliative external beam radiation.