A Critical Appraisal of the Role of Neoadjuvant Chemotherapy for Colorectal Liver Metastases: A Case-Controlled Study H. Z. Malik, 1 S. Farid, 1 A. Al-Mukthar, 1 A. Anthoney, 2 G. J. Toogood, 1 J. P. A. Lodge, 1 and K. R. Prasad 3 1 Hepatobiliary and Transplantation Unit, The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom 2 Oncology Unit, The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom 3 Consultant Hepatobiliary and Transplant Surgeon, The Leeds Teaching Hospitals NHS Trust, St. JamesÕs University Hospital, Beckett Street, Leeds, LS9 7TF, USA Background: The aim of this study was to analyze the outcome of patients that received neoadjuvant chemotherapy prior to resection for colorectal liver metastases (CRLM) and compare them with a matched cohort of patients that underwent resection followed by adjuvant chemotherapy. Methods: 687 patients have undergone curative resection between January 1993 and Jan- uary 2006. In this period, 84 patients received neo-adjuvant chemotherapy and 71 of this group went on to resection. A control group was chosen, matched with these patients, made up of patients who underwent resection followed by adjuvant chemotherapy. Results: There was no difference in clinico-pathological features between the neoadjuvant and the control group. However patients in the control group had more-extended resections and longer hospital stays than those in the neoadjuvant group (p = 0.015). Patients in the control group had an increased incidence of early recurrences (p < 0.001). Despite this, there was no significant difference in either the cancer-specific or the disease-free survival between the two groups of patients. Conclusion: Neoadjuvant chemotherapy has a role in the management of patients with disease that is considered initially unresectable as a down-sizing technique. In patients with resectable disease, the test-of-time approach that neoadjuvant therapy offers is yet to be proven. Key Words: Colorectal liver metastases—Neoadjuvant Chemotherapy—Liver resection—Oxa- liplatin. Colorectal cancer is a common malignancy and 20– 25% of patients will have liver metastases (CRLM) at presentation and with a further 20–30% developing metachronous CRLM following colorectal surgery. Over the last two decades, liver resection has been established as the standard therapy for CRLM and offers the best chance of a potential cure with a five- year survival of about 40%. 1,2 This is partly as a re- sult of improvements in postoperative morbidity and mortality. 3–6 As surgery for CRLM has gained in popularity, the indications for resection have widened considerably. At present, the approach to CRLM is to identify and resect all macroscopic disease to ob- tain a potentially curative resection. 7 To achieve this aim, surgeons often employ a combination of pro- cedures such as hepatic resection and ablative pro- cedures to deal with all macroscopic hepatic disease. Received May 21, 2007; accepted June 27, 2007; published online: October 3, 2007. Address correspondence and reprint requests to: K. R. Prasad; E-mail: raj.prasad@leedsth.nhs.uk Publishedby Springer Science+Business Media, LLC Ó 2007 The Society of Surgical Oncology, Inc. Annals of Surgical Oncology 14(12):3519–3526 DOI: 10.1245/s10434-007-9533-2 3519