The role of liver resection for colorectal cancer metastases in an era of multimodality treatment: a systematic review.
BACKGROUND
To determine the role of liver resection in patients with liver and extrahepatic colorectal cancer metastases and the role of chemotherapy in patients in conjunction with liver resection.


METHODS
MEDLINE and EMBASE databases were searched for articles published between 1995 and 2010, along with hand searching.


RESULTS
A total of 4875 articles were identified, and 83 were retained for inclusion. Meta-analysis was not performed because of heterogeneity and poor quality of the evidence. Outcomes in patients who had liver and lung metastases, liver and portal node metastases, and liver and other extrahepatic disease were reported in 14, 10, and 14 studies, respectively. The role of perioperative chemotherapy was assessed in 30 studies, including 1 randomized controlled trial and 1 pooled analysis. Ten studies assessed the role of chemotherapy in patients with initially unresectable disease, and 5 studies assessed the need for operation after a radiologic complete response.


CONCLUSIONS
The review suggests that: (1) select patients with pulmonary and hepatic CRC metastases may benefit from resection; (2) perioperative chemotherapy may improve outcome in patients undergoing a liver resection; (3) patients whose CRC liver metastases are initially unresectable may benefit from chemotherapy to identify a subgroup who may benefit later from resection; (4) after radiographic complete response (RCR), lesions should be resected if possible.
London Health Sciences, University of Western Ontario, London, Ontario, Canada.
Douglas
D
Quan
Steven
S
Gallinger
Cindy
C
Nhan
Rebecca A
RA
Auer
James J
JJ
Biagi
Glenn G
GG
Fletcher
Calvin H L
CH
Law
Carol-Anne E
CA
Moulton
Leyo
L
Ruo
Alice C
AC
Wei
Robin S
RS
McLeod
D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D018579:Patient Selection; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome