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Hepatobiliary

Presurgical Chemotherapy in Patients Being Considered for Liver Resection

Memorial Sloan-Kettering Cancer Center, New York, New York, USA

Key Words. Neoadjuvant chemotherapy • Liver resection • Hepatotoxicity from chemotherapy

Correspondence: Nancy Kemeny, M.D., Memorial Sloan-Kettering Cancer Center, Gastrointestinal Oncology Service, 1275 York Avenue, Suite H916, New York, New York 10021, USA. Telephone: 212-639-8068; Fax: 212-794-7186

The liver is a frequent site of metastatic disease for colorectal cancer patients. Approximately 15% of patients have liver metastases at diagnosis and another 50% develop metastatic disease to the liver over the course of their disease. Advances in systemic chemotherapy and surgical techniques for hepatic resection have led to longer survival times for these patients. There is no doubt that unresectable patients benefit from systemic chemotherapy. For patients who have resectable disease, the timing of chemotherapy is still not clear. This review addresses the pros and cons of presurgical chemotherapy. The benefits of preoperative chemotherapy include decreasing tumor size, controlling micrometastatic disease, assessing activity of chemotherapy, improving chemotherapy tolerance, and perhaps allowing some prediction of the success of liver resection. The risks for presurgical chemotherapy include liver toxicity, the risk for progression or growth of new sites, secondary splenomegaly, selection of resistant clones, and the possibility of leaving behind active tumor that is no longer seen because of a complete radiographic response. The challenge for the future is to develop a multidisciplinary team approach that can design the best treatment plan for patients with liver metastases.

Disclosure of potential conflicts of interest is found at the end of this article.

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