Thinking Too Fast About Chemotherapy for Resectable Colorectal Cancer Liver Metastases?

Published:April 29, 2022DOI:
      In 2002, the psychologist Daniel Kahneman was a laureate with the Nobel Memorial Prize in Economic Sciences for his notable work on the psychology of judgment and decision-making. He had demonstrated that people frequently fail to fully analyze situations where they must make complex judgments to maximize utility, instead making decisions in a more instinctive and emotional way, using “gut feelings” rather than rational analysis (which he had called a “fast” mode of thought).
      • Kahneman D.
      Thinking, fast and slow.
      This knowledge has changed the understanding of the decision-making process and may help us understand why we are struggling to change practice despite the available data regarding the indication of postoperative chemotherapy (postop-CT) after curative intent liver surgery in colorectal cancer (CRC) patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Colorectal Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kahneman D.
        Thinking, fast and slow.
        Farrar, Straus and Giroux, 2011
        • André T.
        • de Gramont A.
        • Vernerey D.
        • et al.
        Adjuvant fluorouracil, leucovorin, and oxaliplatin in stage II to III colon cancer: updated 10-year survival and outcomes according to BRAF mutation and mismatch repair status of the MOSAIC study.
        J Clin Oncol. 2015; 33: 4176-4187
        • André T.
        • Meyerhardt J.
        • Iveson T.
        • et al.
        Effect of duration of adjuvant chemotherapy for patients with stage III colon cancer (IDEA collaboration): final results from a prospective, pooled analysis of six randomised, phase 3 trials.
        Lancet Oncol. 2020; 21: 1620-1629
        • Seymour M.T.
        • Morton D.
        FOxTROT: an international randomised controlled trial in 1052 patients (pts) evaluating neoadjuvant chemotherapy (NAC) for colon cancer.
        J Clinal Oncol. 2019; 37 (3504-3504)
      1. (NCCN)., N. C. C. N. Colon Cancer (Version 3.2021),

      2. Venook, A. P. & Curley, M. A. in UpToDate (ed Kenneth K Tanabe) (2021).

        • Nordlinger B.
        • Sorbye H.
        • Glimelius B.
        • et al.
        Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial.
        Lancet. 2008; 371: 1007-1016
        • Portier G.
        • Elias D.
        • Bouche O.
        • et al.
        Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases: FFCD ACHBTH AURC 9002 trial.
        J Clin Oncol. 2006; 24: 4976-4982
        • Nordlinger B.
        • Sorbye H.
        • Glimelius B.
        • et al.
        Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial.
        Lancet Oncol. 2013; 14: 1208-1215
        • Kanemitsu Y.
        • Shimizu Y.
        • Mizusawa J.
        • et al.
        Hepatectomy Followed by mFOLFOX6 versus hepatectomy alone for liver-only metastatic colorectal cancer (JCOG0603): a phase II or III randomized controlled trial.
        J Clin Oncol. 2021; JCO2101032
        • Hasegawa K.
        • Saiura A.
        • Takayama T.
        • et al.
        Adjuvant oral uracil-tegafur with leucovorin for colorectal cancer liver metastases: a randomized controlled trial.
        PLoS One. 2016; 11e0162400
        • Wasan H.S.
        • Gibbs P.
        • Sharma N.K.
        • et al.
        First-line selective internal radiotherapy plus chemotherapy versus chemotherapy alone in patients with liver metastases from colorectal cancer (FOXFIRE, SIRFLOX, and FOXFIRE-Global): a combined analysis of three multicentre, randomised, phase 3 trials.
        Lancet Oncol. 2017; 18: 1159-1171
        • Mitry E.
        • Fields A.L.A.
        • Bleiberg H.
        • et al.
        Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials.
        J Clin Oncol. 2008; 26: 4906-4911
        • Ychou M.
        • Hohenberger W.
        • Thezenas S.
        • et al.
        A randomized phase III study comparing adjuvant 5-fluorouracil/folinic acid with FOLFIRI in patients following complete resection of liver metastases from colorectal cancer.
        Ann Oncol. 2009; 20: 1964-1970