Systemic chemotherapy and its implications for resection of colorectal liver metastasis

Background: Liver resection remains the only chance of cure for patients with colorectal liver metastasis. Modern chemotherapy can play a role in the management of these patients but is not without risk. Methods: The online databases Medline and Pubmed were searched to identify relevant articles. Keywords used in these searches were colorectal cancer'', liver metastasis'', chemotherapy'', liver resection'', monoclonal antibody'', steatohepatitis'', sinusoidal obstruction'' and liver regeneration''. Databases were searched for the period January 1970 to September 2009 inclusively. In addition hand referencing of retrieved articles was performed. Results: Modern chemotherapy regimens can effectively downstage initially unresectable disease such that surgical resection can be performed with the prospect of long term cure. There is insufficient evidence however to recommend its use in either the neoadjuvant or adjuvant setting in those with resectable disease from the outset. Conclusion: Chemotherapy can be associated with significant changes to the hepatic parenchyma with subsequent increased risk of morbidity and mortality in the perioperative period. Much work needs to be done to understand the molecular mechanisms underlying these changes to make extended resections safer in patients who are at risk. (C) 2009 Elsevier Ltd. All rights reserved.