Current Concepts in The Management of Colorectal Liver Metastases: A Narrative Review

Colorectal cancer is a leading cause of cancer mortality globally, ranking as the third most common cause of death in males and the second in females. In Sub-Saharan Africa, the estimated incidence is 4.04 per 100,000, with slightly higher rates in men than women.The liver is the most common site for colorectal cancer metastases, with about 50% of patients developing liver metastases during the disease. Multidisciplinary approaches involving colorectal and liver surgeons, oncologists, radiologists, and other specialists have become crucial in managing colorectal liver metastases (CRLM).Historically, liver resections began in the late 19th century, with significant advancements including the development of ultrasonic scalpels, preoperative portal vein embolization, and vascular staplers. The understanding of CRLM progression involves mutations in tumor suppressor genes and oncogenes, leading to uncontrolled cell growth, invasion, and metastasis. Surgical approaches include classical, synchronous, and liver-first strategies. Resectable CRLM typically involves wedge or anatomic resections. For unresectable cases, therapies like radiofrequency ablation, microwave ablation, and hepatic artery infusion could be used. Novel techniques such as two-stage hepatectomy and ALPPS, along with conversion chemotherapy, have improved resection rates and survival outcomes. Finally, the management of CRLM has evolved significantly with advancements in surgical techniques and therapies, emphasizing the need for specialized training and a multidisciplinary approach, particularly in regions like Sub-Saharan Africa.