Role of chemotherapy in resectable liver metastases from colorectal cancer: food for thought from pooled evidence

Surgical resection is the only option of cure for patients with metastatic colorectal cancer; however, the risk of recurrence after metastasectomy is as high as 75% with the liver being the most frequent site of relapse.1 2 Improving the cure rate is a core question in oncology nowadays.Randomised trials analysing the potential use of chemotherapy in the post-metastasectomy setting disclosed that adjuvant chemotherapy improves disease-free survival but not overall survival.3–5 Consequently, routine post-metastasectomy chemotherapy is not recommended. Since clinical trials suffered from small sample sizes, a meta-analysis of all available randomised evidence was recently performed. Despite nearly 500 patients being included, only a positive trend for an overall survival advantage was observed from the use of adjuvant chemotherapy.6In the perioperative setting, the EORTC 40983 trial investigated the role of perioperative FOLFOX compared with metastasectomy alone. Final results with long-term follow-up did not show an overall survival advantage from the use of perioperative chemotherapy.7Overall almost 900 patients had been randomised across trials in both perioperative and postoperative settings, without establishing a statistically significant overall survival benefit for the use of …