Adjuvant chemotherapy after radical liver resection in the treatment of metastases from colorectal carcinoma

Liver metastases are the leading cause of death in patients with colorectal carcinoma: approximately 25% present with metastases at diagnosis of the primary tumor and 30-50% will eventually develop metastases. Surgical therapy for metastases is the only curative treatment that will ensure five-year survival in 30-60% of patients; however, in 30-50% of these patients liver disease will recur. To improve these rates, various different studies have investigated the efficacy of postsurgical adjuvant therapy. The majority of randomized studies evaluated the efficacy of intra-arterial infusion associated or not with postsurgical systemic adjuvant treatment: this approach demonstrated benefit in terms of control of recurrent of liver disease but not in terms of overall survival. A reduction in the recurrence of liver disease was found in the two randomized studies published to date on the efficacy of systemic adjuvant therapy, and an improvement in survival in one trial. Given these data and the results obtained with the use of last generation chemotherapeutic agents (oxaliplatin and irinotecan) in the treatment of unresectable liver metastases from colorectal carcinoma, it can be conjectured that ongoing randomized clinical trials may confirm a significant advantage of adjuvant chemotherapy in the control of recurrence of liver disease and overall survival.