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Background: In patients with initially unresectable colorectal liver metastases (CLMs), several surgical strategies are able to achieve complete clearance of the liver. The survival benefit of these potentially curative approaches is not clearly estimated. Most authors revealed that survival rates achieved by hepatectomy in such patients were significantly lower than in patients with initially resectable CLMs. Methods: All patients who underwent curative-intent hepatectomy for CLMs were retrospectively enrolled. In 533 patients, CLMs were initially resectable. In 45 patients with initially unresectable CLMs it was achieved complete clearance of the liver (by portal vein ligation-11 pts, two-stage liver resection-5 pts, down-sizing chemotherapy-4 pts, hepatectomy associated with radiofrequency ablation-25 pts). Postoperative morbidity, mortality and survival rates were compared between the two groups. Results: Morbidity rate was significantly higher for initially unresectable patients (p = 0.020). Mortality rates were comparable for the two groups (p = 0.634). The 1-, 3and 5-year overall survival rates achieved in patients with initially unresectable CLMs (92%, 48% and 20%, respectively) were similar (p = 0.429) to those achieved in initially resectable patients (88%, 51% and 31%, respectively). Conclusion: In patients with initially unresectable CLMs undergoing complete clearance of the liver, survival rates were comparable to those achieved in initially resectable patients.

Customized charts used during ultrasound examination, which evaluate additional parameters such as body mass index (BMI), may decrease the overdiagnosis of SGA.