Skip Navigation LinksHome > February 2012 - Volume 255 - Issue 2 > Chemotherapy Before Liver Resection of Colorectal Metastases...
Annals of Surgery:
doi: 10.1097/SLA.0b013e3182356236
Reviews and Meta-Analyses

Chemotherapy Before Liver Resection of Colorectal Metastases: Friend or Foe?

Lehmann, Kuno MD*; Rickenbacher, Andreas MD*; Weber, Achim MD; Pestalozzi, Bernhard C. MD; Clavien, Pierre-Alain MD, PhD, FACS*

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Objective: We conducted a systematic review of the published literature to critically assess benefits and risks of the use of preoperative chemotherapy in patients presenting with colorectal liver metastases.

Background: In many centers, chemotherapy is used before hepatic resection of colorectal metastases, even in the presence of a single lesion. Application of chemotherapy requires clear conceptual distinction between patients presenting with resectable lesions (neoadjuvant) versus patients presenting with unresectable lesions, for which chemotherapy is used to reach a resectable situation (downsizing).

Methods: The literature (PubMed) was systematically reviewed for publications related to liver surgery and chemotherapy according to the methodology recommended by the Cochrane Collaboration.

Results: For unresectable liver metastases, combination regimens result in enhanced tumor response and resectability rates up to 30%, although the additional benefit from targeted agents such as bevacizumab or cetuximab is marginal. For resectable lesions, studies on neoadjuvant chemotherapy failed to convincingly demonstrate a survival benefit. Most reports described increased postoperative complications in a subset of patients due to parenchymal alterations such as chemotherapy-associated steatohepatitis or sinusoidal obstruction syndrome.

Conclusion: Preoperative standard chemotherapy can be recommended for downsizing unresectable liver metastases, but not for resectable lesions, for which adjuvant chemotherapy is preferred.

© 2012 Lippincott Williams & Wilkins, Inc.