title: Evolution of missing colorectal liver metastases following inductive chemotherapy and hepatectomy.
abstract: BACKGROUND
  A dramatic response to chemotherapy in some patients with multiple bilateral and initially unresectable liver metastases (LM) from colorectal cancer sometimes leads to their disappearance from imaging studies. Our study was aimed at assessing the evolution of these metastases when they were also not found during liver surgery.
  
  
  METHODS
  Among 104 hepatectomized patients for colorectal LM in 4 years, 15 patients were retrospectively eligible. Eligibility criteria were: initially unresectable LM; a dramatic response to chemotherapy; and the complete disappearance of at least one LM on imaging studies (ultrasonography (US), computed tomography, and magnetic resonance) during more than 3 months. In four patients (27%), the disappeared LM could be found and treated at laparotomy. The main selection criterion for the 11 studied patients of this series was the impossibility of finding and treating the disappeared LM sited in the remaining liver after hepatectomy, resulting in "missing LM."
  
  
  RESULTS
  After a median follow-up of 31 months (range: 18-55) for the series, eight patients among the eleven (73%) did not present any recurrence of the missing LM. The median follow-up was 31.3 months for these eight patients. The three recurrences occurred respectively at 5, 5, and 8 months after surgery.
  
  
  CONCLUSIONS
  The disappearance of LM after chemotherapy on high-quality imaging studies and after intra-operative liver exploration resulted in their definitive cure in approximately 70% of cases. The current dogma stipulating an obligatory resection of the initially affected part of the liver is no longer acceptable.
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Institute, Villejuif, France. elias@igr.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
authors.forename: Omar
authors.initials: O
authors.lastname: Youssef
authors.forename: Lucas
authors.initials: L
authors.lastname: Sideris
authors.forename: Clarisse
authors.initials: C
authors.lastname: Dromain
authors.forename: Olivier
authors.initials: O
authors.lastname: Baton
authors.forename: Valérie
authors.initials: V
authors.lastname: Boige
authors.forename: Michel
authors.initials: M
authors.lastname: Ducreux
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents