Liver-first approach of colorectal cancer with synchronous hepatic metastases: A reverse strategy

Core Tip

Core tip: The liver-first approach or reverse strategy is a downstaging regimen, and it consists of systemic chemotherapy, chemoradiotherapy and/or biological agents, followed by resection of colorectal hepatic metastases prior to removal the primary colorectal tumor. It is a promising strategy in patients with synchronous colorectal liver metastases. The rationale behind this liver-first strategy is initially control of synchronous hepatic metastases of colorectal carcinoma, which can optimize the opportunity of a potentially curative liver resection and longstanding survival. The liver-first strategy can be applied for patients with early stage colorectal carcinoma and synchronous hepatic metastases. Extensive or locally advanced rectal carcinoma with limited or advanced synchronous hepatic metastases and asymptomatic colonic carcinoma with extensive synchronous hepatic metastases may be submitted to the liver-first strategy.