Neo-adjuvant therapy improves resectability rates for colorectal liver metastases

Purpose: Liver resection improves survival in selected patients with colore ctal Liver metastases. However, the majority of patients with colorectal li ver metastases have inoperable disease at presentation. Neo-adjuvant therap y (systemic or regional chemotherapy and interstitial laser therapy) used s ingly or in combination may convert a selected group of patients with irres ectable liver metastases into an operable state. Patients and Methods: We report a series of patients with initially inopera ble multiple colorectal liver metastases who became operable after neo-adju vant therapy. Operability was defined as unilateral disease limited to the liver. Twelve patients (7 female, 5 male, median age 57 years, range 38-69 years) with multiple inoperable colorectal liver metastases (8 synchronous, 4 metachronous) were initially treated with systemic chemotherapy (n = 7), hepatic arterial chemotherapy (n = 2) and chemotherapy plus interstitial l aser therapy (n = 3). Results: In all cases, a significant response was achieved which enabled su bsequent liver resection to be undertaken. There was only one postoperative complication (8%) and no peri-operative deaths. 3 patients were operated o n within the last 12 months and are still alive. Of the remainder, 1 died w ithin 1 year with recurrent disease. The remaining patients have a median s urvival of 2.5 years, range 1.39-4 years. Conclusions: These results are similar to those reported for patients under going resection for operable metastases without neo-adjuvant therapy. Aggre ssive multimodality treatment of colorectal liver metastases in specialised centres may improve the resectability rates and survival in a selected gro up of patients.