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Invited Critique
April 2013

Treatment Sequence for Colorectal Cancer With Hepatic Metastases: Comment on “The Liver-First Approach to the Management of Colorectal Cancer With Synchronous Hepatic Metastases”

JAMA Surg. 2013;148(4):392. doi:10.1001/jamasurg.2013.1236

Jegatheeswaran et al1 have evaluated pooled data from 4 single-center series of patients with colorectal cancer and synchronous hepatic metastases treated witha “liver-first” management strategy.2-5 This well-written article1 tackles a particularly challenging topic given the heterogeneity of patient inclusion criteria and treatment protocols. However, the title is somewhat misleading. The first treatment in all 4 series was, in fact, systemic chemotherapy, the importance of which will be revisited herein. Liver resection was the first surgical intervention, followed by chemoradiotherapy, and then resection of the colorectal primary.

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