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World J Gastroenterol. Jan 7, 2012; 18(1): 16-24
Published online Jan 7, 2012. doi: 10.3748/wjg.v18.i1.16
Multi-modality treatment of colorectal liver metastases
Guo-Xiang Cai, San-Jun Cai
Guo-Xiang Cai, San-Jun Cai, Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Guo-Xiang Cai, San-Jun Cai, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Author contributions: Cai GX wrote the paper; Cai SJ was responsible for writing the outline and revising the paper.
Correspondence to: San-Jun Cai, MD, Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai 200032, China.
Telephone: +86-21-64175590-1108 Fax: +86-21-64035387
Received: March 17, 2011
Revised: June 9, 2011
Accepted: June 16, 2011
Published online: January 7, 2012

Liver metastases synchronously or metachronously occur in approximately 50% of colorectal cancer patients. Multimodality comprehensive treatment is the best therapeutic strategy for these patients. However, the optimal pattern of multimodality therapy is still controversial, and it raises several significant concerns. Liver resection is the most important treatment for colorectal liver metastases. The definition of resectability has shifted to focus on the completion of R0 resection and normal liver function maintenance. The role of neoadjuvant and adjuvant chemotherapy still needs to be clarified. The management of either progression or complete remission during neoadjuvant chemotherapy is challenging. The optimal sequencing of surgery and chemotherapy in synchronous colorectal liver metastases patients is still unclear. Conversional chemotherapy, portal vein embolization, two-stage resection, and tumor ablation are effective approaches to improve resectability for initially unresectable patients. Several technical issues and concerns related to these methods need to be further explored. For patients with definitely unresectable liver disease, the necessity of resecting the primary tumor is still debatable, and evaluating and predicting the efficacy of targeted therapy deserve further investigation. This review discusses different patterns and important concerns of multidisciplinary treatment of colorectal liver metastases.

Keywords: Colorectal cancer, Liver metastases, Multimodality therapy