Author(s): Adam R, Avisar E, Ariche A, Giachetti S, Azoulay D,
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Abstract BACKGROUND: Surgical resection is the most effective treatment for colorectal liver metastases but only a minority of patients are candidates for a potentially curative resection. Our experience with neoadjuvant chemotherapy followed by resection and five years survival analysis of the patients treated is presented. METHODS: Between February of 1988 and September of 1996, 701 patients with unresectable colorectal liver metastases were treated with neoadjuvant chemotherapy. Four categories of nonresectable disease were defined: large size, ill location, multinodularity, and extrahepatic disease. Liver resection was performed in those patients whose disease became resectable. After resection, the patients were followed up every 3 months. A 5-year survival analysis by the different categories described was performed. RESULTS: Ninety-five patients (13.5\%) were found to be resectable on reevaluation and underwent a potentially curative resection. There was no perioperative mortality, and the complication rate was 23\%. As of December of 1999, 87 patients have completed 5 years of follow-up. The overall 5-year survival is 35\% from the time of resection and 39\% from the onset of chemotherapy. Respective 5-year survival rates are 60\% for large tumors, 49\% for ill-located lesions, 34\% for multinodular disease, and 18\% for liver metastases with extrahepatic disease. In this latter category, however, a 35\% 5-year survival was found when all the patients with extrahepatic disease were analyzed rather than only those for whom extrahepatic disease was the main cause of nonresectability. CONCLUSIONS: Neoadjuvant chemotherapy enables liver resection in some patients with initially unresectable colorectal metastases. Long-term survival is similar to that reported for a priori surgical candidates.
This article was published in Ann Surg Oncol
and referenced in Journal of Carcinogenesis & Mutagenesis