title: Resection of colorectal liver metastases following neoadjuvant chemotherapy.
abstract: OBJECTIVE
  Hepatic resection in metastatic disease from colorectal cancer offers the best chance in selected cases for long-term survival. Neoadjuvant chemotherapy (NACT) has been advocated in some cases initially deemed irresectable, with few reports of the efficacy of such a strategy and the influence of the response to chemotherapy on the outcome of radical hepatic resection.
  
  
  METHODS
  Between December 1995 and May 2005, 27 patients with colorectal liver metastases (seven males, 20 females, mean age: 58 ± 8 years; range: 40-75) were treated with neoadjuvant chemotherapy. A seven-year survival analysis was performed. Chemotherapy included mainly 5-fluorouracil, leucovorin and either oxaliplatin or irinotecan for a median of eight courses.
  
  
  RESULTS
  A total of 16 patients (59%) had synchronous and 11 (41%) metachronous metastases. During pre-operative chemotherapy, tumour regression occurred in ten cases (37%), stable disease in a further ten patients (37%) and progressive disease developed in seven cases (26%). The five-year overall survival for NACT responders was 64% and only 15% for non-responders (p=0.044).
  
  
  CONCLUSIONS
  The response to chemotherapy is likely to be a significant prognostic factor affecting survival after liver resection for cure.
authors.affiliation: Department of General Surgery-Laparoscopic Surgery, European Institute of Oncology, University of Milano, 20141, Italy.
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authors.lastname: Chiappa
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authors.lastname: Bertani
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authors.lastname: Biffi
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authors.lastname: Pace
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authors.lastname: Viale
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authors.lastname: Pruneri
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authors.lastname: Zampino
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authors.lastname: Fazio
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authors.lastname: Orsi
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authors.lastname: Bonomo
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authors.lastname: Monfardini
authors.forename: P Della
authors.initials: PD
authors.lastname: Vigna
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authors.lastname: Andreoni