The Role of Peri-operative Chemotherapy for Resectable Colorectal Liver Metastasis: What Does the Evidence Support?

Abstract

With improved patient selection, better surgical techniques, and more effective cytotoxic chemotherapy agents, 5-year survival following curative intent surgery of colorectal metastasis now approaches 45–60%.1–4 While there have been significant advances in prolonging overall survival of patients with colorectal liver metastasis, many patients still develop recurrent disease. De Jong et al.5 reported a contemporary experience in which the 5-year disease-free survival was only 30% following curative intent surgery for colorectal liver metastasis, with 60% of patients developing extrahepatic disease at 5 years. Tomlinson et al.6 noted that approximately one third of actual 5-year survivors succumb to cancer-related death. Noting that the chance of “cure” after hepatectomy was roughly a one-in-six chance, the authors estimated a “maximal cure” rate of only about 25% for patients undergoing surgical resection of colorectal liver metastasis. Given the persistent high recurrence rates and the overall poor “true” long-term survival following surgical resection of colorectal liver metastasis, there has been great interest in the use of adjuvant chemotherapy for patients with resectable colorectal liver metastasis. The role of adjuvant chemotherapy after resection of colorectal cancer liver metastasis has recently been reviewed by Power and Kemeny.7 For both pedagogical and practical purposes, “peri-operative” chemotherapy for colorectal liver metastasis can be divided into three different treatment “strategies;” neoadjuvant, peri-operative, and adjuvant. We herein review each one of these peri-operative chemotherapy treatment strategies for resectable colorectal liver metastasis.