Resectable distant metastases in colorectal cancer: management strategies

Introduction. Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide, with a 
substantial proportion of patients presenting with or developing distant metastases. Historically, metastatic CRC has been 
considered an incurable condition, warranting only palliative chemotherapy. However, over the past two decades, this 
paradigm has undergone a fundamental shift, driven by the adoption of the oligometastatic disease concept and advances 
in local treatment modalities.
Materials and Methods. The cornerstone of current management is the recognition that limited metastatic spread (1–5 
lesions, involving no more than two organs) may be potentially curable provided that all tumour deposits are completely 
eradicated. Surgical resection of liver and lung metastases is the best-studied approach: in carefully selected patients, R0 
resection achieves 5-year overall survival rates of 40–50%, far exceeding outcomes with systemic therapy alone. Resectability 
criteria include the feasibility of radical removal while preserving sufficient functional organ reserve, control of extrahepatic/
extrapulmonary disease, and favourable tumour biology. For synchronous metastases, simultaneous, staged, or liver-first 
strategies are available, with the choice being individualised. Alternative or complementary modalities include thermal 
ablation (radiofrequency and microwave) and stereotactic body radiotherapy, which are particularly valuable for small lesions 
and in patients unfit for surgery; their combination with surgery and systemic therapy yields the best long-term results. 
Less common sites, such as retroperitoneal lymph nodes and the brain, may also be targeted locally within a multimodality 
approach, and several studies have reported survival benefits, although evidence for these locations remains less systematic.
Conclusion. Contemporary management of patients with resectable distant metastases from CRC demands a 
personalised strategy based on prognostic stratification, functional reserve assessment, and molecular tumour characteristics. 
Multidisciplinary collaboration among oncologists, surgeons, radiation oncologists, and interventional radiologists is 
essential to define the optimal sequence and combination of treatments. Future research should focus on refining selection 
criteria, optimising perioperative systemic therapy, and integrating novel local technologies to expand the boundaries of 
resectability, thereby improving both survival and quality of life.