Oxaliplatin and irinotecan have widened the chemotherapy alternatives available to patients with metastatic colorectal cancer, and effective targeted agents have further improved treatment efficacy. Combinations of these drugs have set a new benchmark of survival at ∼20 months, enabling a substantial number of patients who were not candidates for resection to qualify for the procedure. Liver resection after tumor downsizing has yielded encouraging results, although cure is rarely achieved. Based on several theoretical advantages, preoperative chemotherapy is increasingly being used also in patients with resectable disease. However, the debate is still ongoing especially with respect to the oncologic benefits and the numerous drawbacks, including hepatic toxicity and the risk of inducing a complete radiologic response.
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