Treatment strategies for XXXX with synchronous liver metastases: Which way to go?

@entity1 @entity5 @entity14
AIM: To offer an up-to-date review of all available treatment strategies for @entity1 with synchronous colorectal liver metastases (CLM). METHODS: A comprehensive literature search was performed to identify articles related to the management of @entity1 with synchronous CLM. A search of the electronic databases PubMed, MEDLINE, and Google Scholar was conducted in September 2014. The following search terms were used: synchronous colorectal liver metastases, surgery, stage IV @entity14 , liver-first approach, and up-front hepatectomy. These terms were employed in various combinations to maximize the search. Only articles written in English were included. Particular attention was devoted to studies and review articles that were published within the last six years (2009-2014). Additional searches of the cited references from primary articles were performed to further improve the review. The full texts of all relevant articles were accessed by two independent reviewers. RESULTS: Poor long-term outcomes of @entity1 with synchronous CLM managed by a traditional treatment strategy have led to questions about the timing and sequence of possible therapeutic interventions. Thus, alternative paradigms called reverse strategies have been proposed. Presently, there are four treatment strategies available: (1) primary first approach (or traditional approach) comprises resection of the primary @entity14 followed by chemotherapy; subsequent liver resection is performed 3-6 mo after colorectal resection (provided that CLM are still resectable); (2) simultaneous resection of the primary @entity14 and CLM during a single operation presents intriguing options for a highly select group of @entity1 , which can be associated with significant postoperative morbidity; (3) liver-first (or chemotherapy-first) approach comprises preoperative chemotherapy (3-6 cycles) followed by liver resection, adjuvant chemotherapy, and resection of the primary @entity14 (it is best suited for @entity1 with asymptomatic @entity5 and initially unresectable or marginally resectable CLM); and (4) up-front hepatectomy (or "true" liver-first approach) includes liver resection followed by adjuvant chemotherapy, colorectal resection, and adjuvant chemotherapy (strategy can be offered to @entity1 with asymptomatic @entity5 and initially resectable CLM). CONCLUSION: None of the aforementioned strategies appears inferior. It is necessary to establish individual treatment plans in multidisciplinary team meetings through careful appraisal of all strategies.
