title: Survival and recurrence after neo-adjuvant chemotherapy and liver resection for colorectal metastases: a ten year study.
abstract: BACKGROUND
  Currently liver resection offers the only potential cure for colorectal liver metastases (CRLM). We prospectively audited the outcome of CRLM treated by a combination of neo-adjuvant chemotherapy and surgery.
  
  
  METHODS
  283 consecutive patients underwent liver resection for CRLM over 10 years with curative intent. Patients received chemotherapy preoperatively for synchronous and early (< 2 years) metachronous metastases. Univariate and multivariate analyses were used to identify mortality risk factors.
  
  
  RESULTS
  Overall survival at 1, 3 and 5 years was 90%, 59.2% and 46.1%, respectively. Disease free survival at 1, 3 and 5 years was 68.1%, 34.8% and 27.9%, respectively. Operative mortality was 2.1% and morbidity was 23.7%. Patients with macroscopic diaphragm invasion by tumour, CEA > 100 ng/ml, tumour size > 5 cm or cancer involved resection margins (CIRM) had a significantly worse overall survival. Incidence of CIRM and re-resection was 4.9% and 4.5%, respectively.
  
  
  CONCLUSIONS
  Neo-adjuvant chemotherapy followed by liver surgery is associated with improved survival and low CIRM and re-resection rates.
authors.affiliation: The Royal Surrey County Hospital, Guildford, Surrey, UK.
authors.forename: N D
authors.initials: ND
authors.lastname: Karanjia
authors.forename: J T
authors.initials: JT
authors.lastname: Lordan
authors.forename: W J
authors.initials: WJ
authors.lastname: Fawcett
authors.forename: N
authors.initials: N
authors.lastname: Quiney
authors.forename: T R
authors.initials: TR
authors.lastname: Worthington
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents