Conditions

Liver Tumors & Metastases

Surgical evaluation and treatment of primary liver cancers, colorectal metastases, and other hepatic lesions — including hepatic arterial infusion pump therapy.

Overview

Types of Liver Tumors

Liver tumors are broadly divided into primary liver cancers (arising from liver cells) and secondary tumors (metastases that have spread to the liver from another cancer). The workup and treatment strategy differ significantly depending on the type.

The most common indication for liver surgery in the United States is colorectal liver metastases — spread of colorectal cancer to the liver. This is also where surgery has the greatest potential for cure. Other important indications include hepatocellular carcinoma, metastases from neuroendocrine tumors, and selected cases of other primaries.

Tumor Types

Colorectal liver metastases (CRLM)Most common; potentially curative with surgery
Hepatocellular carcinoma (HCC)Primary liver cancer; usually in setting of cirrhosis
Neuroendocrine metastasesOften slow-growing; resection can improve survival and symptoms
Benign lesions (hemangioma, FNH, adenoma)Most require no surgery; adenomas >5 cm or in women on OCPs may warrant resection

Colorectal Metastases

When Liver Metastases Are Curable

Surgery for colorectal liver metastases (CRLM) is one of the most impactful interventions in surgical oncology — with cure possible in a meaningful proportion of patients.

Who Is a Candidate?

Patients whose liver disease can be completely resected with adequate future liver remnant, and who have no uncontrollable extrahepatic disease. The number and size of lesions matter less than whether a complete resection is achievable.

Staged or Simultaneous Resection

Colorectal cancer and liver metastases may be removed in one operation (simultaneous) or in staged procedures. The choice depends on the extent of both the primary tumor and the liver disease, patient fitness, and institutional approach.

HAI Pump Therapy

Hepatic arterial infusion (HAI) pump delivers FUDR directly to the liver after resection, reducing recurrence rates. It is also used to convert unresectable liver-only colorectal metastases to resectable disease. HAI is offered at select specialized centers including Mount Sinai.

Primary Liver Cancer

Hepatocellular Carcinoma

HCC most commonly develops in patients with cirrhosis (from hepatitis B, hepatitis C, alcohol-related liver disease, NAFLD/NASH, or other causes). Management must account for both the tumor and the underlying liver function.

Surgical resection — For patients with localized HCC and adequate liver function (normal or Child-Pugh A). Future liver remnant calculation is essential.
Liver transplantation — For patients within Milan criteria (single tumor ≤5 cm or ≤3 tumors each ≤3 cm). Offers both tumor treatment and cure of the underlying cirrhosis.
Locoregional therapy — TACE, TARE (Y-90), and ablation are used for patients not suitable for resection or as a bridge to transplantation.

Hepatic Resection

The Surgery

Liver surgery ranges from minor resections (wedge, single segment) to major hepatectomies (removal of 3 or more segments). The extent of resection is planned using volumetric CT analysis to ensure adequate future liver remnant.

Future Liver Remnant (FLR): The volume of liver that will remain after surgery must be sufficient to support liver function. In a normal liver, a FLR of ≥20% is generally adequate. In a cirrhotic or chemotherapy-damaged liver, ≥40% may be required. Portal vein embolization (PVE) can be performed to grow the future remnant before surgery when needed.

FAQ

Frequently Asked Questions

Can colorectal cancer that has spread to the liver be cured?
Yes. Surgical resection of colorectal liver metastases (CRLM) is potentially curative, with 5-year survival rates of 40–50% after complete resection with modern chemotherapy. All liver disease must be resectable with adequate remaining liver volume and no uncontrollable disease elsewhere. This should be evaluated at a hepatobiliary surgery center.
What determines whether a liver tumor can be removed surgically?
Resectability depends on tumor size, number, relationship to major vessels and bile ducts, the volume of liver that will remain after surgery, and the health of the underlying liver. CT volumetric analysis guides surgical planning. Patients with inadequate future liver remnant may be candidates for portal vein embolization before surgery.
What is hepatic arterial infusion (HAI) pump therapy?
HAI pump delivers chemotherapy directly into the hepatic artery via a surgically implanted pump, achieving very high drug concentrations in the liver with low systemic exposure. It is used primarily for colorectal liver metastases — as adjuvant therapy after liver resection or to convert unresectable disease to resectable. It is offered at select high-volume centers.
What is the difference between resection and ablation?
Hepatic resection physically removes the tumor and surrounding tissue. Ablation destroys tumors in place using heat (microwave or radiofrequency). Resection is the gold standard when feasible. Ablation is useful for small tumors in locations not amenable to resection, or as a complement to surgery.

Get an Expert Liver Surgery Evaluation

If you or a family member has liver metastases or a primary liver tumor — including a prior opinion that surgery is not possible — a specialist evaluation is appropriate.

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