**1. Introduction**

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 colorectal cancer regarding the methods, indications and limits.

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‐ formed [9].

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 and reliable plan for postoperative treatment.

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 presence of residual tumour or early recurrence.

If the surgical treatment is not possible, other options must be considered, including systemic or transarterial chemotherapy; embolisation; ablation by cryotreatment, radiofrequency or microwaves; or radiotherapy and targeted external beam radio therapy [1].

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

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.
