Background. We examined overall and disease-free survivals in a cohort of patients subjected to resection of liver metastasis from colorectal cancer (CRLM) in a 10-year period when new treatment strategies were implemented. Methods. Data from 239 consecutive patients selected for liver resection of CRLM during the period from 2002 to 2011 at a single center were used to estimate overall and disease-free survival. The results were assessed against new treatment strategies and established risk factors. Results. The 5-year cumulative overall and disease-free survivals were 46 and 24%. The overall survival was the same after reresection, independently of the number of prior resections and irrespectively of the location of the recurrent disease. The time intervals between each recurrence were similar (11 1 months). Patients with high tumor load given neoadjuvant chemotherapy had comparable survival to those with less extensive disease without neoadjuvant chemotherapy. Positive resection margin or resectable extrahepatic disease did not affect overall survival. Conclusion. Our data support that one still, and perhaps to an even greater extent, should seek an aggressive therapeutic strategy to achieve resectable status for recurrent hepatic and extrahepatic metastases. The data should be viewed in the context of recent advances in the understanding of cancer biology and the metastatic process. 1. Introduction The incidence of colorectal cancer (CRC) is increasing and is now the fourth leading cause of cancer deaths worldwide [1]. Twenty percent of the patients present with synchronous liver metastases and another 30–40% develop liver metastases during followup [2]. Hepatic resection remains the only potentially curable treatment and is now offered to 20–25% of the patients whereas only 10% were selected for this treatment ten years ago [3]. The main exclusion criteria for liver resection of colorectal liver metastases (CRLMs) are nonresectable liver metastasis (tumor growth into both portal branches and/or into both left and right liver vein), inadequately functioning residual liver parenchyma, or nonresectable extrahepatic disease. These exclusion criteria have all been challenged in recent years. Close followup after primary CRC (early detection of metastasis), implementation of new surgical techniques including two-stage hepatectomy with portal vein embolization [4, 5] and transplantation methods, and the introduction of new chemotherapy and biological agents capable of converting inoperable cases to a resectable status by tumor downsizing have increased
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