ABSTRACT
The major advance in the treatment of metastatic colorectal cancer in recent years has been the increase in efficiency of chemotherapy regimens and the consequent possible change in resectability of hepatic metastases, offering a possibility of cure through a multidisciplinary approach. It is estimated that 15-20% of colorectal cancer patients present with synchronous liver metastases1 and approximately half of the patients with colorectal tumors will experience liver failure at some point during the course of their disease.2 In almost one-third of cases, the liver is shown at autopsy to be the only site of cancer spread.3
This is in accordance with the 20-45% 5-year survival rate obtained with surgical resection of hepatic metastases.4-9 Unfortunately, however, only 10-20% of patients presenting with liver metastases are amenable to curative resection.10-12 Palliative and symptomatic treatment is commonly offered to the remaining patients, and the median survival does not exceed 15-18 months. Over the past 8 years, we have managed these patients in a protocol of neoadjuvant chemotherapy. Using a multidisciplinary approach, liver resection has been routinely reconsidered in all cases of objective response to the treatment. This chapter summarizes our experience with this approach.
