Influence of chemotherapy in the treatment of colorectal liver metastases

Surgical treatment by radical hepatectomy, only curative treatment of colorectal liver metastases, is feasible in 75 to 85% of patients. Our works was singular because it has shown in 1990 that chemotherapy allowed to cured patient with primarily unresectable colorectal liver metastases. Our experience involved now more than 200 such patients with a 5-year and 10-year overall survival of 30% and 18%, respectively. This difficult surgery implies 55% of major hepatectomies, 36% of repeat hepatectomies (until 4 successive hepatectomies for one patient) and 20% of associated pulmonary resection. Simultaneously of chemotherapy success, we have developed principle of liver parenchyma increasment to allow major hepatectomies without post-operative liver insufficiency due to small liver remnant. Recently, new chemotherapies including monoclonal antibodies against tumoral growth factors (cetuximab) and vascular growth factors (bevacizumab) are more efficient and allow better tumoral reduction to obtain more chances to be resected, the only goal of oncosurgical strategy.