Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases

The purpose of this study was to compare the treatment and outcome in patients referred for staged resection of synchronous colorectal liver metastases. The records of patients who had undergone colon or rectal resection and were then referred for evaluation of clinically resectable synchronous liver metastases between January 1995 and January 2000 were reviewed. Comparisons were made between patients who did not receive neoadjuvant chemotherapy and had exploratory operations after recovery from colon resection and patients who did receive chemotherapy before liver resection. A total of 106 patients were treated during the 5-year period. Neoadjuvant chemotherapy was given to 52 of the patients; in 29 of them the disease did not progress, but in 17 patients the disease progressed while they were receiving treatment. Median follow-up was 30 months. Patient- and tumor-related variables were similar between groups. Five-year survival was statistically similar between patients who did and those who did not receive neoadjuvant chemotherapy (43% vs. 35%, P=0.49). Patients within the neoadjuvant group whose disease did not progress while they were receiving chemotherapy experienced significantly improved survival as compared to patients who did not receive chemotherapy (85% vs. 35%, P=0.03). In the setting of synchronous colorectal liver metastases, the response to neoadjuvant chemotherapy may be a prognostic indicator of survival and may assist in the selection of patients for conventional or experimental adjuvant therapies.