A sequential approach combining neoadjuvant and adjuvant chemotherapy with surgery markedly boosts survival for high-risk colorectal liver metastasis patients.

• Patients receiving neoadjuvant chemotherapy had a median progression-free survival of 1.1 years versus 0.6 years for surgery-first patients (p<0.001).
• Overall survival was better in the neoadjuvant group: 5.2 years compared to 4.3 years (p=0.044).

Completing the entire treatment sequence correlates with the best outcomes.

• Matched analysis confirmed these findings, indicating a clear benefit to neoadjuvant therapy before surgery.