, Volume 16, Issue 7, pp 1762-1764,
Open Access This content is freely available online to anyone, anywhere at any time.
Date: 17 Mar 2009

Synchronous Colorectal Liver Metastases: Triumph Of Prospective Randomized Trials Over Observational Bias Leads To Paradigm Shift

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“We can’t solve problems by using the same kind of thinking we used when we created them.”

Albert Einstein

The last one and a half decade has witnessed an exciting era for the management of advanced colorectal cancer, with emergence of effective combination chemotherapy, potent biologic agents, surgical techniques for safe hepatic resection and ancillary procedures such as portal vein embolization and radiofrequency ablation. Integration of these various interventions within the context of a multidisciplinary approach has fostered an aggressive stance amongst oncologists.1 This approach continues to be pushed forward with attempts to “tease out” additional patients who may become candidate for curative hepatic resection and hence alter the natural history of their disease.2

In this issue, Reddy et al comprehensively review the current evidence for outcomes in the management of synchronous colorectal liver metastases (CRLM) and inquire whether a paradigm shift is necessary.3 Let us examine