
Liver Metastases-General Discussion 

Liver metastases create a life-threatening prognosis. However, tremendous strides have been made in dealing with liver mets in the past decade, such as improved diagnostic capabilities, safe surgical resection, availability of safe nonsurgical ablative modalities, multimodality therapy, and aggressive approach to recurrent disease. Remember, the liver has the capacity to regenerate its tissue, not like lung or kidney.

It is now accepted that liver resection should be done surgically as the treatment of choice when the complete excision of all demonstrable tumor with clear resection margins is feasible.  
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In the presence of other abdominal tumors or of inoperable lung tumors, however, local treatment may not be the treatment of choice, and systemic treatment might be more appropriate.

If liver tumors are inoperable, ablative methods are probably the techniques of choice, if the tumor size and location are favorable.  If the liver tumors are inoperable, and cannot be ablated, neoadjuvant treatment with systemic chemotherapy or one of these local techniques might downsize the tumors so that they become surgically resectable.

Regional chemotherapy might be useful combined with hepatic resection or as palliative therapy. Patients with localized, unresectable hepatic metastases or coexisting serious medical condition(s) may be candidates for radiation, percutaneous ethanol injection, cryosurgery, percutaneous radiofrequency, microwave ablation, laser ablation, hypoxic flow-stop perfusions with bioreductive alkylating agents, hepatic arterial ligation, embolization or chemoembolization. These new liver-directed types of treatment are being investigated and may offer new approaches to providing palliation and prolonging survival.  

For primary or secondary tumors of the liver, six existing minimally invasive techniques for the treatment of primary and secondary malignant hepatic tumors--radio-frequency ablation, microwave ablation, laser ablation, cryosurgical ablation, ethanol ablation, and chemoembolization have each exceeded clinical results obtained with conventional chemo- or radiation therapy. Thus, for nonsurgical patients, these techniques are becoming standard independent or adjuvant therapies. In addition, with continued improvement in technology and increasing clinical experience, one or more of these minimally invasive techniques may soon challenge surgical resection as the treatment of choice for patients with limited hepatic tumor. 
