title: Resectable colorectal liver metastases: optimal sequencing of chemotherapy.
abstract: BACKGROUND
  Hepatic resection is a potentially curative option for patients with colorectal liver metastases who are candidates for surgery. With the increasing availability of highly effective chemotherapy, surgery may be further advanced by the improved tumor response and better long-term outcomes associated with its use in the perioperative setting.
  
  
  METHODS
  A commentary about the optimal timing of chemotherapy from the currently available evidence was performed.
  
  
  RESULTS
  There is evidence to suggest that adjuvant chemotherapy after surgery for colorectal liver metastases improves disease-free and overall survival. The recent EORTC trial (40983) by Nordlinger and co-workers provides evidence for improved progression-free survival with the use of perioperative chemotherapy compared to surgery alone.
  
  
  CONCLUSIONS
  Both adjuvant and perioperative chemotherapy appear to be beneficial over surgery alone for resectable colorectal liver metastases. Whether one is superior over the other remains unknown. Participation in ongoing trials to optimize the perioperative sequencing of chemotherapy would be important in identifying the optimal peri-surgical chemotherapy management of resectable colorectal liver metastases.
authors.affiliation: Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, University of New South Wales, Kogarah, NSW, 2217, Sydney, Australia. terence.chua@unsw.edu.au
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D020360:Neoadjuvant Therapy; D011379:Prognosis; D015996:Survival Rate