Table 5.

Secondary resection in patients with initially unresectable liver metastases

Improve patient selection through early and continued consultation in a multidisciplinary team approach, including close cooperation among a radiologist, medical oncologist, and surgeon with experience in liver resection

Conduct surgical evaluation at baseline and, if disease is initially unresectable, reevaluation at intervals during therapy to determine if conversion to resectability has been achieved

Set appropriate goals of therapy (best response, conversion to resectable disease, or palliation)

Determine length of therapy, with consideration for the risk of potential toxicities

Consider the safety profile of individual agents and the risks of overtreatment, including hepatotoxicity

If the treatment goal is conversion to resection, treat to resectability and not to best response