**2. Epidemiology of colorectal cancer**

Colorectal cancer is among the leading malignant tumours both by incidence and by death rate [1]. Globally, in the year 2012, it was the 3rd most frequent cancer in men and the 2nd in women [2]. The incidence and mortality is higher in males (Table 1). The highest incidence rates are found in Australia and New Zealand, Europe and North America contrasting with low incidence in Africa and South Central Asia. As shown in Table 2, the incidence is generally higher in more developed countries [2]. The decrease in colorectal cancer incidence in USA reflects successful screening and removal of colorectal adenomas. The incidence growth, recently observed in Western Asia (Kuwait and Israel) and Eastern Europe (Czech Republic and Slovakia), reflects increased prevalence of risk factors as diet, obesity and smoking.


1 Among all cancers.

**1. Introduction**

170 Recent Advances in Liver Diseases and Surgery

formed [9].

Colorectal cancer (CRC) represents one of the leading malignant tumours both by incidence and death rate [1, 2]. Metastatic spread to liver occurs in 70–75% of patients, and 20–35% of CRC patients present with synchronous liver metastases [1, 3, 4]. Although the presence of metastatic disease significantly adversely affects the survival, a wide scope of treatment options exists. To ensure that each colorectal cancer patient receives the best care, the medical society should be well informed about the possibilities in the treatment of liver metastases of

Surgery is the preferred option for long term survival. The operation extent ranges from major hepatic resection (trisegmentectomy, hepatectomy, extended hepatectomy, and hemihepatec‐ tomy) to parenchyma-sparing minor resection such as segmentectomy or wedge resection [4]. Laparoscopic approach and robotic surgery can be considered, especially in advanced centres [5, 6]. In patients with questionable adequacy of the liver remnant and wide intrahepatic tumour spread, portal vein occlusion, forced liver hypertrophy and staged resection can be helpful [7, 8]. Recently, liver transplantation for metastatic colorectal cancer has been per‐

Surgery at present assumes significant role in treatment of metastatic liver lesions. However, it demands not only appropriate surgical technique but also correct preoperative diagnosis

Adequately timed and exact imaging is necessary prior to the surgical or nonsurgical treatment to reveal the metastases and assess the feasibility of resection. Magnetic resonance imaging (MRI), computed tomography (CT), ultrasonography (US) and 18F-2fluoro-D-glucose posi‐ tron emission tomography in association with computed tomography (PET-CT) are used for imaging metastatic lesions in the liver [1]. The radiologic evaluation can be combined with traditional and novel cancer markers [10–12] and biopsy examination. Among serological markers, carcinoembryonic antigen (CEA) has been used traditionally despite the limitations [4] and lack of unified guidelines. MicroRNAs represent a rapidly advancing research field hopefully yielding diagnostic blood tests to diagnose the cancer by location and to identify the

If the surgical treatment is not possible, other options must be considered, including systemic or transarterial chemotherapy; embolisation; ablation by cryotreatment, radiofrequency or

Due to the wide scope of treatment options, the median survival of patients affected by metastatic colorectal cancer has increased significantly [13, 14]. The 5-year and 10-year survival

In conclusion, liver metastases of colorectal cancer represent a frequent and serious condition. The remarkable medical advances request dynamic systematisation of up-to-dated evidence. The present chapter on the surgical treatment of colorectal cancer metastases is intended to summarise the present knowledge in regard to the approach to patient with liver metastases

of colorectal cancer, discussing the diagnostics, treatment and evaluation of response.

microwaves; or radiotherapy and targeted external beam radio therapy [1].

colorectal cancer regarding the methods, indications and limits.

and reliable plan for postoperative treatment.

presence of residual tumour or early recurrence.

reaches 58% and 36%, correspondingly [15].

ASR, age-standardised ratio per 100,000.

**Table 1.** Global incidence and mortality attributable to colorectal cancer (2012) by Globocan data [16]


1 Includes Europe, North America, Australia, New Zealand and Japan.

2 Includes Africa, Asia (except Japan), Latin America, Melanesia, Micronesia and Polynesia.

ASR, age-standardised ratio per 100,000.

**Table 2.** Incidence and mortality caused by colorectal cancer by regional welfare [2]

Colorectal cancer could be prevented avoiding obesity, alcohol, smoking and excessive consumption of red and processed meat, as well as maintaining physical activity. There are also several screening methods, including guaiac-based or immunochemical test for occult blood in stools, faecal DNA test, virtual colonoscopy by computed tomography imaging, double-contrast barium enema, flexible sigmoidoscopy and colonoscopy [2]. MicroRNA stool test could appear in the nearest future. Despite the possibilities of prevention and screening, metastatic disease is common. Metastatic spread to liver occurs in 70–75% of patients, and 20– 35% of CRC patients are diagnosed with synchronous liver metastases [1, 3, 4]. Although the presence of metastatic disease significantly adversely affects the survival, a wide scope of treatment options exist.
