Background: Surgical resection is the only potentially curative treatment f
or colorectal liver metastases, with 5-year survival rates approaching 40 p
er cent. However, at present only 20-25 per cent of such lesions are deemed
resectable. This review examines developments in neoadjuvant and adjuvant
treatments of colorectal liver metastases that aim to improve the results o
f surgical management of this disease.
Methods: A literature review was undertaken based on a Medline search from
1970 to May 1998.
Results: Further evolution in surgical technique is unlikely to lead to a d
ramatic increase in the resectability rate of colorectal liver metastases.
Recent developments in neoadjuvant and adjuvant chemotherapy schedules, tog
ether with a range of interventional radiological procedures and interstiti
al lyric techniques, show promise in terms of extending the limits of resec
tability and decreasing recurrence rates associated with these lesions. Usi
ng multimodality regimens 5-year survival rates of 40 per cent are now bein
g reported for lesions that were initially considered irresectable.
Conclusion: Patients with colorectal liver metastases should be assessed in
units that can offer all the specialist techniques necessary to deliver op
timum care. Incorporation of newer neoadjuvant and adjuvant treatments into
management strategies should occur in the setting of randomized trials.