Chemotherapy Before Liver Resection of Colorectal Metastases

Friend or Foe?

Kuno Lehmann, MD; Andreas Rickenbacher, MD; Achim Weber, MD; Bernhard C. Pestalozzi, MD; Pierre-Alain Clavien, MD, PhD, FACS

Disclosures

Annals of Surgery. 2012;255(2):237-247. 

In This Article

Conclusion

Taken together, the data indicates that for unresectable liver metastases, downsizing chemotherapy may offer a chance for secondary resection in about a third of patients. Although the optimal regimen for this is still unclear, it seems reasonable to start with 2 cytotoxic drugs (5FU with either oxaliplatin or irinotecan). If this strategy fails, adding an antibody (cetuximab), or HAI may be an alternative in the absence of extrahepatic disease. In contrast, routine neoadjuvant chemotherapy cannot be recommended due to the increased risk of complications without clear benefit on survival. In patients with multiple, borderline resectable tumors, neoadjuvant therapy may identify good responders with favorable tumor biology and thus a better outcome.

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