title: Neo-adjuvant therapy improves resectability rates for colorectal liver metastases.
abstract: OBJECTIVE
  Liver resection improves survival in selected patients with colorectal liver metastases. However, the majority of patients with colorectal liver metastases have inoperable disease at presentation. Neo-adjuvant therapy (systemic or regional chemotherapy and interstitial laser therapy) used singly or in combination may convert a selected group of patients with irresectable liver metastases into an operable state.
  
  
  METHODS
  We report a series of patients with initially inoperable multiple colorectal liver metastases who became operable after neo-adjuvant 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 laser therapy (n = 3).
  
  
  RESULTS
  In all cases, a significant response was achieved which enabled subsequent liver resection to be undertaken. There was only one postoperative complication (8%) and no peri-operative deaths. 3 patients were operated on within the last 12 months and are still alive. Of the remainder, 1 died within 1 year with recurrent disease. The remaining patients have a median survival of 2.5 years, range 1.39-4 years.
  
  
  CONCLUSIONS
  These results are similar to those reported for patients undergoing resection for operable metastases without neo-adjuvant therapy. Aggressive multimodality treatment of colorectal liver metastases in specialised centres may improve the resectability rates and survival in a selected group of patients.
authors.affiliation: Department of Surgery, Royal Free and University College Medical School, University College London, Charles Bell House, 67-73 Riding House Street, London W1P 7LD, UK.
authors.forename: A
authors.initials: A
authors.lastname: Shankar
authors.forename: P
authors.initials: P
authors.lastname: Leonard
authors.forename: A J
authors.initials: AJ
authors.lastname: Renaut
authors.forename: J
authors.initials: J
authors.lastname: Lederman
authors.forename: W R
authors.initials: WR
authors.lastname: Lees
authors.forename: A R
authors.initials: AR
authors.lastname: Gillams
authors.forename: E
authors.initials: E
authors.lastname: Harrison
authors.forename: I
authors.initials: I
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D015996:Survival Rate; D016896:Treatment Outcome