In the next three articles, groups from Emory University and Loma Linda University take us through the actual events surrounding surgery. In the third article, David Kooby talks about important perioperative considerations that make hepatic resection safe and reliable (3). Next, Naveen Solomon discusses the actual surgical techniques that are used in surgical resection, weighing the risks and benefits of each (4). In the fifth article, Magi Senthil walks us through the important points of postoperative management of liver resection patients (5). In the last three articles, teams from Methodist Hospital, Johns Hopkins Inhibitors,research,lifescience,medical University,

and Roger Williams Medical Center discuss additional topics of more complex presentations of hepatic metastasis. Bridget Fahy presents the issues and treatment options for the synchronous presentation of hepatic metastasis with the colorectal primary (6). Next, Tim Pawlik discusses the treatment approaches for patients with extrahepatic metastasis, including which Inhibitors,research,lifescience,medical patients with hepatic metastasis and limited extrahepatic disease should Inhibitors,research,lifescience,medical be considered for surgical resection (7). see more Finally, Joe Espat presents the topic of thermal ablation for hepatic metastasis, including how it

can be used to extend options for surgical resection and its role in unresectable disease (8). In summary, CRC with liver metastasis is a challenging problem. However, there Inhibitors,research,lifescience,medical are now safe and effective surgical options that are an important

part of a multidisciplinary treatment approach that can result in long-term survival and cure. Footnotes No potential conflict of interest.
Colorectal cancer (CRC) continues to be one of the leading causes of significant health problems and cancer-related death in the world. Each year about one million people are diagnosed with CRC worldwide with an estimated 140,000 individuals being diagnosed in the United States (1). About one-half of patients will either present with colorectal liver metastasis (CLM) or develop Inhibitors,research,lifescience,medical them aminophylline during the course of their disease (2,3). While roughly 20% of all patients will present with synchronous liver metastasis, another 25-30% will present with metachronous disease (4-7). Common sites of extra-hepatic metastatic disease include the lung, hilar/peri-hepatic lymph nodes, as well as the peritoneum (8-12). While systemic chemotherapy remains the cornerstone of therapy for patients with stage IV colorectal disease, some patients are optimally managed with the addition of surgical therapy (13-17). Previous data on patients with extrahepatic disease (EHD) and CLM have suggested that these patients have a poor prognosis (18-20). As such, in most instances, EHD was traditionally considered a strong relative or absolute contraindication to surgical resection.