Use of neoadjuvant and postoperative chemotherapy with surgical resection of colorectal cancer hepatic metastases

Hepatic metastases from colorectal cancer are common in patients presenting with an initial diagnosis of metastatic disease or at the time of recurrence. For many patients, the liver may be the only site of meta-static disease. Surgical resection of the metastases may provide long-term benefit, but their size, number, or location may limit the possibility of a resection. A growing body of literature from both retrospective patient series and prospective clinical trials suggests that preop-erative therapy may enhance the chance for resection and improve outcome for initially unresectable or not optimally resectable metastases. In selected situations, neoadjuvant chemotherapy also may be beneficial for patients with potentially resectable metastases. Further trials are needed to refine the guidelines for preopera-tive and perioperative chemotherapy.