Organ targeted mini-invasive approach in the treatment of colorectal cancer liver metastases: role of intraoperative ultrasonography as guidance in liver resection.

Abstract Surgery is still considered the gold standard therapy for patient carries of colorectal liver metastases (CLM) because related to more chance of long-term survival. The major limitation of surgical approach is its technical feasibility because of the inability to completely clear the metastatic disease in a single operation while preserving enough future liver remnant. Thus, the two-stage hepatectomy is generally recommended for these patients. We have shown how with an extensive use of intraoperative ultrasonography based on strict criteria is possible performing curative resection in a single stage despite complex tumor presentation as in multifocal and bilateral spread. This strategy aims to keep the liver skeleton although allowing the radical tumor clearance: as consequence it is minimized the need for a multistep surgical strategy, and is enhanced the feasibility of repeated hepatectomies in the event of recurrent disease.