Timing of Liver Surgery for Colorectal Liver Metastases will be Influenced by Tumor Behavior

We all know that surgery remains the best chance of cure for patients with colorectal liver metastases (CLM). Within 2 years following resection, half of the patients will experience recurrence, but it is commonly accepted that repeat resection, when technically feasible, provides excellent long-term outcomes, joining that of patients without recurrence. One should nevertheless bear in mind that these prolonged survivals are often the result of the multimodal management of the patients, which combines sophisticated morphological follow-up, percutaneous ablative therapies and, above all, systemic chemotherapy. In the current study, Vigano et al. confirm these previous findings but also provide new insights regarding the pattern of recurrences of patients operated for CLM. Using rigorous data arising from the well-known LiverMetSurvey registry, they have specifically focused on the 10 % of patients experiencing early (\6 months) recurrence following resection of CLM. Not surprisingly, the authors observed that such recurrences were more likely to occur in patients with pejorative factors, including advanced primary disease, synchronous metastatic spread, high number of lesions, surgical margin invasion, and absence of adjuvant chemotherapy. Also, they established that early recurrences were associated with impaired long-term prognosis, especially when not amenable to repeated resection. While these valuable findings favor an all oncosurgical approach and are in line with what might have been expected, several important key aspects still remain to be discussed. WHICH SURGICAL MARGIN?