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Neo-adjuvant therapy improves resectability rates for colorectal liver metastases
A Shankar1, P Leonard, A J Renaut
1Department of Surgery, Royal Free and University College Medical School, University College London, Charles Bell House, 67-73 Riding House Street, London W1P 7LD, UK.
Annals of the Royal College of Surgeons of England
|April 26, 2001
Summary
Neoadjuvant therapy can convert inoperable colorectal liver metastases into an operable state, enabling liver resection. This aggressive multimodality treatment improves resectability and survival rates in selected patients.
Area of Science:
- Oncology
- Hepatobiliary Surgery
- Gastrointestinal Oncology
Background:
- Colorectal liver metastases (CLM) are common, with most patients presenting with inoperable disease.
- Liver resection offers survival benefits but is limited by resectability.
- Neoadjuvant therapy aims to convert unresectable CLM to a resectable state.
Purpose of the Study:
- To evaluate the efficacy of neoadjuvant therapy in converting initially inoperable multiple CLM to an operable status.
- To assess the safety and survival outcomes following liver resection after neoadjuvant treatment.
Main Methods:
- Retrospective analysis of 12 patients with initially inoperable multiple CLM.
- Neoadjuvant treatments included systemic chemotherapy, hepatic arterial chemotherapy, or chemotherapy with interstitial laser therapy.
- Operability was defined as unilateral disease limited to the liver.
Main Results:
- All patients achieved a significant response, enabling subsequent liver resection.
- One postoperative complication (8%) and no peri-operative deaths were recorded.
- Median survival was 2.5 years (range 1.39-4 years), with 3 patients alive and disease-free within 12 months.
Conclusions:
- Neoadjuvant therapy can significantly improve resectability rates for patients with initially inoperable CLM.
- Multimodality treatment in specialized centers may enhance outcomes for selected CLM patients.
- Aggressive neoadjuvant approaches can lead to comparable survival to upfront resection of operable metastases.