ABSTRACT
The management of patients with small hepatic metastases from colorectal cancer and other histologies requires the consideration of many diverse patient and tumor related factors. These factors include the natural history of the tumor type, the expected cure rate after surgical treatment, effectiveness of alternative treatments, and the morbidity of surgical resection. In general, the indications for any major surgical procedure include the potential for cure, prolongation of survival and palliation of symptoms. For metastatic tumors to the liver in selected cases the cure rate may be over 50% for colorectal cancer, 1 but will be exceedingly rare for other histologies such as gastric cases, and melanoma and sarcoma. Small metastases to the liver generally do not cause symptoms (except for hormone secreting neuroendocrine tumors) and, therefore, palliation of symptoms is not a common indication for management of these lesions. Nevertheless, many issues remain unresolved. Does resection of a small solitary hepatic metastasis prolong survival in cases where the patient is likely to develop widespread metastases in the future? Is there any harm in allowing a tumor to go untreated for a period of time, knowing that with close followup the resection option may still be possible in the future? Do metastases metastasize such that a delay in management may obviate the curative option? Unfortunately, all of these difficult issues are only addressed by sparse data in the literature.
