title: Role of neoadjuvant chemotherapy in the treatment of multiple colorectal metastases to the liver.
abstract: BACKGROUND
  The role of neoadjuvant chemotherapy for patients with multiple (five or more) bilobar hepatic metastases irrespective of initial resectability is still under scrutiny. The purpose of this study was to compare the outcome of hepatectomy alone with that of hepatectomy after neoadjuvant chemotherapy for multiple bilobar hepatic metastases from colorectal cancer.
  
  
  METHODS
  Retrospective data were collected from 71 patients after hepatectomy for five or more bilobar liver tumours. The outcome of 48 patients treated by neoadjuvant chemotherapy followed by hepatectomy was compared with that of 23 patients treated by hepatectomy alone.
  
  
  RESULTS
  Patients who received neoadjuvant chemotherapy had better 3- and 5-year survival rates from the time of diagnosis than those who did not (67.0 and 38.9 versus 51.8 and 20.7 per cent respectively; P = 0.039), and required fewer extended hepatectomies (four segments or more) (39 of 48 versus 23 of 23; P = 0.027). Multivariate analysis showed neoadjuvant chemotherapy to be an independent predictor of survival.
  
  
  CONCLUSIONS
  In patients with bilateral multiple colorectal liver metastases, neoadjuvant chemotherapy before hepatectomy was associated with improved survival and enabled complete resection with fewer extended hepatectomies.
authors.affiliation: Department of Surgery II, Yokohama City University School of Medicine, Yokohama, Japan. ktrj112@urahp.yokohama-cu.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: R
authors.initials: R
authors.lastname: Adam
authors.forename: H
authors.initials: H
authors.lastname: Shimada
authors.forename: D
authors.initials: D
authors.lastname: Azoulay
authors.forename: F
authors.initials: F
authors.lastname: Lévi
authors.forename: H
authors.initials: H
authors.lastname: Bismuth
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome