title: 'Liver-first' approach for metastatic colorectal cancer.
abstract: The liver-first approach was proposed for the first time in 2006 to obtain resectability of stage IV colorectal cancer patients and complete the therapeutic plan. From then some groups have used this new revolutionary approach reporting promising results. Other alternative strategies have been proposed for metastatic patients. The authors reviewed the literature weighing the pros and cons of each strategy proposed to manage these advanced tumor stages. The therapeutic options are analyzed in the light of oncologic problems and evidence. Also problems, questions and perspectives are given. Even if the 'liver-first' approach seems to be a promising strategy, the ideal diagnostic-therapeutic flowchart for metastatic colorectal cancer is still difficult to standardize. The great heterogeneity of this population of patients is one of the main problems. A 'tailored approach' philosophy is necessary to calibrate, in a multidisciplinary setting, a case-by-case choice of therapeutic options.
authors.affiliation: Department of Surgery & Medical-Surgical Specialties, General & Oncologic Surgery Unit, Vittorio-Emanuele University Hospital, University of Catania, 95122 Catania, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Donati
authors.forename: Gregor A
authors.initials: GA
authors.lastname: Stavrou
authors.forename: Axel
authors.initials: A
authors.lastname: Stang
authors.forename: Francesco
authors.initials: F
authors.lastname: Basile
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Oldhafer
mesh_terms: D000465:Algorithms; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D009367:Neoplasm Staging; D013997:Time Factors
keywords: colorectal liver metastasis; liver-first; metastatic cancer; multidisciplinary tumor board; neoadjuvant chemotherapy; rectal cancer