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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2012

01-04-2012 | Hepatobiliary Tumors

A Systematic Review of Clinical Response and Survival Outcomes of Downsizing Systemic Chemotherapy and Rescue Liver Surgery in Patients with Initially Unresectable Colorectal Liver Metastases

Authors: Vincent W. T. Lam, FRACS, Calista Spiro, MBBS, Jerome M. Laurence, FRACS, Emma Johnston, FRACS, Michael J. Hollands, FRACS, Henry C. C. Pleass, FRACS, Arthur J. Richardson, FRACS

Published in: Annals of Surgical Oncology | Issue 4/2012

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Abstract

Background

Selected patients with unresectable colorectal liver metastases (CLM) may be rendered resectable after systemic chemotherapy. We reviewed the evidence of downsizing systemic chemotherapy followed by rescue liver surgery in patients with initially unresectable CLM.

Methods

Literature search of databases (Medline and PubMed) to identify published studies of neoadjuvant chemotherapy followed by liver resection in patients with initially unresectable CLM was undertaken and focused on response rate of chemotherapy and survival outcomes.

Results

Ten observational studies were reviewed. A total of 1,886 patients with initially unresectable CLM underwent systemic chemotherapy. An objective response was observed in 64% (range, 43–79%) of patients after systemic chemotherapy. Of these, 22.5% underwent macroscopically curative liver resection. Median overall survival was 45 (range, 36–60) months with 19% of patients alive and recurrence-free.

Conclusions

Current evidence suggests that downsizing systematic chemotherapy followed by rescue liver resection is safe and effective for selected patients with initially unresectable CLM. Further studies are required to examine response rates and secondary resectability using new targeted molecular therapy-based regimens.
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Metadata
Title
A Systematic Review of Clinical Response and Survival Outcomes of Downsizing Systemic Chemotherapy and Rescue Liver Surgery in Patients with Initially Unresectable Colorectal Liver Metastases
Authors
Vincent W. T. Lam, FRACS
Calista Spiro, MBBS
Jerome M. Laurence, FRACS
Emma Johnston, FRACS
Michael J. Hollands, FRACS
Henry C. C. Pleass, FRACS
Arthur J. Richardson, FRACS
Publication date
01-04-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 4/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-2061-0

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