title: Chance of cure following liver resection for initially unresectable colorectal metastases: analysis of actual 5-year survival.
abstract: BACKGROUND
  Survival with long-term follow-up following liver resection for unresectable colorectal liver metastases (CRLM) downsized by chemotherapy has rarely been reported. The aim of this study was to determine the chance of cure following liver resection for initially unresectable CRLM.
  
  
  METHODS
  Between January 2000 and December 2009, 61 patients underwent hepatectomy for unresectable liver-only CRLM downsized after chemotherapy. Cure was defined as a recurrence-free interval of at least 5 years after primary hepatectomy.
  
  
  RESULTS
  Resectability of CRLM was achieved after a mean number of 11 courses, and 42.6 % of patients underwent liver resection after ≥10 courses. Postoperative mortality was nil, and morbidity rate was 19.7 %. The 5- and 10-year actuarial overall survival rates were 42.6 and 16.0 %. Of 30 patients with a follow-up ≥5 years, 11 were alive, yielding a 5-year actual overall survival rate of 36.7 %, and 7 (23.3 %) were considered cured because they are alive without recurrence. On multivariate analysis, response to chemotherapy was the only independent predictor of both overall and disease-free survival.
  
  
  CONCLUSIONS
  Cure can be achieved in about 23 % of patients resected for initially unresectable CRLM downsized by chemotherapy. Liver resection can be safely performed in selected patients even after multiple courses of chemotherapy.
authors.affiliation: Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart, School of Medicine, L.go A. Gemelli, 8, 00168, Rome, Italy. francesco.ardito@rm.unicatt.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Ardito
authors.forename: Maria
authors.initials: M
authors.lastname: Vellone
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cassano
authors.forename: Agostino M
authors.initials: AM
authors.lastname: De Rose
authors.forename: Carmelo
authors.initials: C
authors.lastname: Pozzo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Coppola
authors.forename: Bruno
authors.initials: B
authors.lastname: Federico
authors.forename: Ivo
authors.initials: I
authors.lastname: Giovannini
authors.forename: Carlo
authors.initials: C
authors.lastname: Barone
authors.forename: Gennaro
authors.initials: G
authors.lastname: Nuzzo
authors.forename: Felice
authors.initials: F
authors.lastname: Giuliante
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult