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Objective
Report the safety and outcomes following the introduction of routine periopereative multiagent chemotherapy in the multidisciplinary treatment of patients with colorectal liver metastases (CRLM).

Background
Increasingly preoperative chemotherapy is integrated into the management of patients with liver metastases. This strategy has likely expanded the number of surgical candidates but postoperative safety and survival have not been clearly defined.

Methods
We performed a retrospective review of all patients undergoing liver resections for metastatic colorectal cancer between 2003 and 2011 in a single academic oncology center. Demographic data, tumor characteristics, chemotherapy, details of surgical procedure, complications and survival were analyzed.

Results
The study population consisted of 158 patients that underwent 169 liver operations. 11(6.9%) patients had repeat resections. Median length of follow up from a first liver resection was 22.3 months. 87 (55%) patients presented with synchronous lesions. 114 patients (72%) underwent chemotherapy prior to the liver resection (of them 68% FOLFOX, 12% FOLFIRI). Mean size of the lesions 3.97 cm (0.2 -18 cm) .Preoperative Portal Vein Embolization was utilized in 16 (10.1%) patients Overall survival was 89%, 57% and 17% at 1, 3 and 5 years respectively. Median survival was 42.8 months. Perioperative mortality (30, 60 and 90 days respectively) was 1.26%, 1.89 % and 2.53 %. Overall complication rate was 24% (5% - liver related) The complication rate was not significantly different if patients had preoperative chemotherapy (27% no chemotherapy, 24 % with chemotherapy). Mean length of stay was 8.68 days. On univariate analysis negative predictors of survival included positive margins, > 3 lesions, patient age >70 years. On a multivariate analysis only the presence of >3 lesions predicted poor survival.

Conclusions
In recent years preoperative oxaliplatin-based chemotherapy has become commonplace in the management of patients with resectable CRLM. Our results suggest that even with chemotherapy and resection only a subset of patients remain disease free after 5 years. However, even in high risk patient with multiple lesions, preoperative chemotherapy may be administered safely without increase in postoperative complications. These results support the use of perioperative chemotherapy particularly in patients with multifocal ( > 3 lesions) metastatic disease in the liver.