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Annals of Surgical Oncology, 13(10):1271 1280 DOI: 10.1245/s10434-006-9045-51The University of Texas M. D Anderson Cancer Center, Houston, TX USA2Centre Hpato-Biliaire, Hopital Paul Brousse, Villejuif, France3John Wayne Cancer Institute, Santa Monica, CA USA4Centre de Chirurgie Viscerale et de Transplantation, Hautepierre Hospital, Strasbourg, France 5Department of Surgery, University of Wisconsin Medical School, Madison, WI USA Key Words: Radiofrequency ablationPreoperative chemotherapyLiver resectionPortal vein embolizationColorectal metastases.tases are eligible for resection, the absolute number of patients amenable to resection is large and is growing with better imaging, better surgery, and improvements in systemic therapies to reduce the risk of both intrahepatic and extrahepatic recurrences.3,12 16 Forpatients with liver metastases, a multidisciplinary team approach has become mandatory.Advances made by chemotherapy have been the major determinant of new therapeutic approaches concerning primarily unresectable patients. Until recently, patients with unresectable hepatic colorectal metastases were treated with palliative chemotherapy, and almost no such patients survived for 5 years.17,18 Recently, advances in chemotherapy have permitted resection in some patients with initially unresectable metastases.Chemotherapy regimens based on 5-uorouracil (5-FU) rarely provided sucient intrahepatic tumoricidal eect to convert hepatic metastases from unresectable to resectable (response rate < 20%). However, novel chemotherapeutic regimens combining 5-FU, folinic acid, and oxaliplatin and/or irinotecan19 26 have been associated with improved response rates (around 50%), allowing 10% 30% of patients with initially unresectable hepatic metastases to be rescued by liver surgery.13,14,22 In addition,early results from trials evaluating several novel biologic agents, including cetuximab27 and bevacizumab,26 suggest that even more patients with initially unresectable disease may respond to primaryImproving Resectability of Hepatic Colorectal Metastases: Expert Consensus StatementEddie K. Abdalla, MD,1 ReneAdam, MD, PhD,2 Anton J. Bilchik, MD, PhD,3 Daniel Jaeck, MD,4 Jean-Nicolas Vauthey, MD,1,6 and David Mahvi, MD5PROOFDOWNSTAGING OF UNRESECTABLE METASTASES AND TIMING OF LIVER RESECTIONColorectal cancer is the third most common malignancy in Western countries.1,2 Approximately 50% of patients with colorectal cancer develop hepatic metastases during the course of the disease.3 5The liver is the most common site of metastases of colorectal cancer, and hepatic metastases are responsible for death in at least two thirds of patients with colorectal malignancy.3,4At present, the only accepted potentially curative standard treatment in patients with liver metastases of colorectal cancer is liver resection. After resection, the 5-year overall survival rate in selected patients is 37% 58%...