Updated 20 January 2006

The liver is a common site of secondary spread from a number of different primary cancers.

Most patients have multiple bilobar metastases which are usually managed in a palliative manner by chemotherapy regimens designed for that specific histology or site. However, metastases which are solitary or limited to resectable location within the liver may best be treated by resection. Assessment of resectability is best made by triphasic CT or CT angiography.

Although most tumours considered for resection originate from the colon and rectum, rarely metastatic tumours from other sources can be resected if the primary tumour is apparently cured and there is no extra-hepatic disease. Prolonged observation of potentially resectable tumours in the liver is generally not advised.

Indications for resection of hepatic metastases of colorectal cancer are changing. Surgical management of liver metastases, other than those that can be removed by a wedge excision usually at the time of the original operation, should be performed by experienced hepato-biliary surgeons.

Palliative chemotherapy may be used. The choice of drugs and likelihood of response depends on the primary cancer. Chemoembolization, hepatic arterial infusion, radiation with hepatic artery microspheres, alcohol injection and radio-frequency ablation are considered developmental techniques that may be tried in selected patients.