Abstract
Combining surgery and chemotherapy in the treatment of patients with colorectal hepatic
metastases is increasingly becoming the standard of care. However, controversy remains
regarding the juxtapositioning of chemotherapy and surgery, the duration of chemotherapy,
and particularly, the use of preoperative chemotherapy in the treatment of patients
with initially resectable metastases. The arguments for and against the different
approaches presented are based on the data published in the medical literature and
on the data presented at the most recent major oncology meetings, coupled with the
personal experience of the authors. For patients with liver metastases that are resectable
at presentation, perioperative chemotherapy has become the standard treatment in many
institutions, with the recommendation that surgery is performed after a maximum of
6 cycles of systemic therapy. In the case of patients with initially unresectable
liver metastases receiving preoperative systemic therapy, patients should be carefully
monitored and surgery performed as soon as the metastases become resectable. All patients
should, where possible, be treated by a multidisciplinary team. Going forward, it
needs to be established whether more intensive treatment (ie, perioperative versus
postoperative systemic therapy) is merited for the treatment of patients with initially
resectable disease, and what the precise contribution of new therapeutic agents in
these settings is, based on new prospective randomized trial data.
Keywords
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Article info
Publication history
Accepted:
April 6,
2010
Received in revised form:
February 24,
2010
Received:
January 26,
2010
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