Use of Chemotherapy in the Resection of Liver Metastases of Colorectal Cancer

R0 resection has proved curative in a subset of patients with colorectal liver metastases. Unfortunately, the incidence of recurrence is high. For this reason, chemotherapy has been used at the preoperative and/or postoperative settings in clearly resectable disease in an attempt to eradicate micrometastasis and, hopefully, increase the oncological benefit of resection. For patients whose disease is not resectable but would become resectable as a result of a substantial response to treatment, chemotherapy is used to "convert" unresectable to resectable disease. This paper will review the use of perioperative chemotherapy, discuss issues regarding administration of chemotherapy before or after surgery, and review evidence regarding the use of specific cytotoxic and targeted agents.