Management of Secondary Hepatic Neoplasms

Secondary hepatic neoplasms refer to tumors that metastasize to the liver, a spectrum that includes carcinomas, neuroendocrine cancers, sarcomas, and gastrointestinal stromal tumors. Systemic chemotherapy or targeted therapy may improve survival but rarely results in cure. Better control of disseminated disease with systemic therapy and advances in the perioperative management of patients undergoing liver surgery have expanded the eligibility to undergo surgical resection. Colorectal cancer is the most frequent secondary neoplasm in the liver. Selected patients with limited colorectal and neuroendocrine metastases represent the most common indications for resection. In patients with noncolorectal, nonneuroendocrine metastases, resection is more controversial and reserved for patients with adequate control of the primary lesion and favorable tumor biology, usually reflected in a long disease-free interval. This chapter focuses on the oncologic principles regarding secondary neoplasms and indications for resection; it also provides an overview of systemic therapy and a description of other locoregional therapies.