Hepatic resection of colorectal liver metastasis in the presence of extrahepatic disease

The pioneers of liver surgery for colorectal liver metastases (CRLM) rapidly identified patients with extrahepatic disease (EHD) as a cohort with particularly poor survival. Indeed, until recently, the presence of EHD was considered a contraindication to hepatic resection due to poor long-term outcomes(Fong et al., 1999). As the safety of liver resection has improved and multimodal approaches have widened the cohort of patients to whom surgery offers benefit, and the global collective experience has broadened, many surgeons now argue that resection of EHD in selected patients may offer a survival advantage. Interpretation of data is frequently challenging due to selection bias and the inherent variability of the clinical scenarios encountered. In this chapter, we review the current evidence in this often controversial field and discuss the factors that influence prognosis of patients with CRLM and EHD.