Long-term results of resection following downstaging of initially unresectable colorectal metastases

Colorectal carcinoma is a significant health problem with over half of all patients experiencing systemic metastasis. Fortunately for these patients, the recent introduction of more effective systemic chemotherapy drugs has ushered in a new and exciting era in the treatment of metastastic colorectal cancer. Not only have these novel regimens improved the outlook for patients with unresectable disease, lengthening the median survival from 10 months to 24 months, they are allowing patients previously thought to be unresectable the opportunity for a potentially curative hepatic resection. A growing literature has been written describing chemotherapy response rates in patients who were initially considered "unresectable" and describing the long-term outcome for the subset of these responders who are resected. This report summarizes this literature, focusing on the prognostic factors that have been identified to determine which patients receive the most and those who receive the least benefit from resection following treatment with systemic chemotherapy.