Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2024; 30(7): 663-672
Published online Feb 21, 2024. doi: 10.3748/wjg.v30.i7.663
Current landscape of preoperative neoadjuvant therapies for initial resectable colorectal cancer liver metastasis
Xiao-Fei Cheng, Feng Zhao, Dong Chen, Fan-Long Liu
Xiao-Fei Cheng, Dong Chen, Fan-Long Liu, Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Feng Zhao, Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Co-corresponding authors: Xiao-Fei Cheng and Fan-Long Liu.
Author contributions: Cheng XF and Liu FL conceptualized the study; Zhao F conducted the investigation; Cheng XF wrote the original draft; Cheng XF, Chen D, and Liu FL reviewed and edited the manuscript; All authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Fan-Long Liu, MD, PhD, Academic Editor, Doctor, Professor, Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China.
Received: December 7, 2023
Peer-review started: December 7, 2023
First decision: December 18, 2023
Revised: December 22, 2023
Accepted: January 22, 2024
Article in press: January 22, 2024
Published online: February 21, 2024

Colorectal cancer liver metastasis (CRLM) presents a clinical challenge, and optimizing treatment strategies is crucial for improving patient outcomes. Surgical resection, a key element in achieving prolonged survival, is often linked to a heightened risk of recurrence. Acknowledging the potential benefits of preoperative neoadjuvant chemotherapy in managing resectable liver metastases, this approach has gained attention for its role in tumor downsizing, assessing biological behavior, and reducing the risk of postoperative recurrence. However, the use of neoadjuvant chemotherapy in initially resectable CRLM sparks ongoing debates. The balance between tumor reduction and the risk of hepatic injury, coupled with concerns about delaying surgery, necessitates a nuanced approach. This article explores recent research insights and draws upon the practical experiences at our center to address critical issues regarding considerations for initially resectable cases. Examining the criteria for patient selection and the judicious choice of neoadjuvant regimens are pivotal areas of discussion. Striking the right balance between maximizing treatment efficacy and minimizing adverse effects is imperative. The dynamic landscape of precision medicine is also reflected in the evolving role of gene testing, such as RAS/BRAF and PIK3CA, in tailoring neoadjuvant regimens. Furthermore, the review emphasizes the need for a multidisciplinary approach to navigate the complexities of CRLM. Integrating technical expertise and biological insights is crucial in refining neoadjuvant strategies. The management of progression following neoadjuvant chemotherapy requires a tailored approach, acknowledging the diverse biological behaviors that may emerge. In conclusion, this review aims to provide a comprehensive perspective on the considerations, challenges, and advancements in the use of neoadjuvant chemotherapy for initially resectable CRLM. By combining evidence-based insights with practical experiences, we aspire to contribute to the ongoing discourse on refining treatment paradigms for improved outcomes in patients with CRLM.

Keywords: Neoadjuvant therapy, Colorectal cancer liver metastasis, Multidisciplinary teams, Chemotherapeutic regimens, Resectability criteria

Core Tip: Optimizing treatment for colorectal cancer liver metastasis (CRLM) is essential. This review explores the dynamic landscape of preoperative neoadjuvant chemotherapy for initially resectable CRLM, addressing debates, criteria for patient selection, and the role of gene testing. Emphasizing a multidisciplinary approach, it navigates complexities in managing progression post-chemotherapy, contributing to ongoing discussions on refining treatment paradigms for improved outcomes.