The neoadjuvant chemotherapy is a systematic chemotherapy applied for the treatment of cancer, before radical surgery or radiotherapy, also known as preoperative chemotherapy. Since 1982, Frei firstly proposed the concept of neoadjuvant chemotherapy, and thereafter its clinic effect and value were recognized gradually. According to the theory of first-order kinetics of Skipper [2], administration of a certain amount of anticancer drugs can only kill a certain percentage of cancer cells, which is not associated with the number of cancer cells existing in the treatment, that is, it is not a fixed number of cells, which provided the basis for the preoperative chemotherapy. Therefore, administration of sufficient large dose of anticancer drugs within the tolerance range of the patients is allowed. The proportion of the proliferating cells among the tumor cell is called growth fraction (GF). During the early stage, there are fewer tumor cells, GF is greater, and the time of growth is short, relatively sensitive to the cell-cycle-specific drugs. And in the advanced tumor, the number of the tumor cells increases, GF decreases, and the time of growth extends, which reduces the sensitivity to the cell-cycle-specific drugs, but at this time, the use of a large dose of cell-cycle-specific drugs may reduce the volume of the tumor cells and promote the increase of the GF, and the sensitivity of the cell-cycle-specific drugs will increase. Therefore, before resection of primary foci of the tumor, administration of chemotherapy drugs is sensitive and effective to the treatment of small cancer foci; besides, it also has killing effect on the primary focus. Therefore, theoretically the earlier the chemotherapy is given, the less the drug-resistant cell strains. Moreover, many animal model tests showed that after the tumor resection, the stimulating factors to promote the cancer cell growth would be induced to accelerate the metastasis focus growth, inducing the cancer cells to form the clones with the anti-chemotherapy drug characteristics. In addition, through the preoperative chemotherapy, the number of the tumor cells reduces, thus inhibiting the production of such growth-stimulating factor and slowing down the growth of the metastasis foci. Compared with postoperative chemotherapy, the advantages of the neoadjuvant chemotherapy are as follows:

For the patients of non-metastases of colorectal cancer, whether or not they should accept the neoadjuvant chemotherapy, the “guidelines of diagnosis and comprehensive treatment of liver metastases of colorectal cancer draft” (2009 edition) specifies that “generally, the stage III preoperative patients, if they have no bleeding, obstruction or perforation, etc., can accept the neoadjuvant chemotherapy, with the regimens of FOLFOX, capecitabine alone or 5-FU/LV and the recommended time is 1–3 months before the surgery” [4, 5].

However, there are no EBM evidences for the patients of non-metastases of colorectal cancer for whether or not to accept the neoadjuvant chemotherapy (intravenous chemotherapy). But as recommended by the NCCN Guidelines of Colon Cancer in 2010, these patients are not applicable to accept the neoadjuvant chemotherapy (intravenous chemotherapy), but directly accept the surgery.

Since the higher recurrence rate and demanding for continuing the physiological functions after radical resection of rectal cancer, the neoadjuvant therapy of rectal cancer mainly focuses on the combined therapy of preoperative local radiotherapy and chemotherapy, to enhance the R0 operative resection rate and reduce the local recurrence rate. But there is no great significance of improving the patients’ overall survival [6–9].

The injection of the chemotherapy drugs in the hepatic artery for preoperative interventional therapy is mainly based on the following: (1) the multiplication rate of the tumors – for the patients with delayed liver metastasis after the radical operation, their livers have the “small metastasis” that cannot be discovered through the existing imaging techniques before operation; after surgical removal of primary foci, the inhibited factor of blood vessels are removed, which activates the growth of the dormant micrometastatic tumor and causes the occurrence of distant metastasis [13, 14]; (2) the blood supply of the micrometastasis with the diameter of 0.5–3 mm in the liver is mainly from the hepatic artery, and this micrometastasis is just the target of preoperative intervention therapy [15].

Sadahiro from the University of Tokyo firstly reported the randomized controlled trial of preoperative preventative hepatic artery intervention therapy of colorectal cancer in 2004. There were 305 cases of stage II and stage III colorectal cancer patients involved in this study, and no preoperative liver metastasis has been discovered for the patients. The 305 patients were divided into two groups randomly: 119 cases of preoperative hepatic artery intervention group (3-week perioperative 5-FU continuous observation of hepatic artery chemotherapy) and 186 cases of surgery alone group. The results showed that, for the stage III patients, the preoperative intervention therapy can reduce the postoperative recurrence rate by 60 % (95 % CI 0.24–0.64; P = 0.0002), mortality rate 63 % (95 % CI 0.21–0.67; P = 0.0009), and liver metastasis rate 62 % (95 % CI 0.22–0.66; P = 0.0005), but no effect for the metastasis of other organs. There is no curative effect for the stage II patients [16].

The General Surgery Department, Zhongshan Hospital affiliated to Fudan University firstly carried out the clinical study of prophylactic hepatic and regional arterial infusion chemotherapy (PHRAIC) in China and obtained the preliminary results. The PHRAIC group of patients were firstly subject to the prophylactic hepatic and regional arterial infusion chemotherapy: infusion of the fluorodeoxyuridine 500 mg, MMC 10 mg, and oxaliplatin 50 mg, respectively, to the hepatic artery and the major feeding arteries of the tumor; after 7 days of chemotherapy, the patients accepted the radical surgery of colorectal cancer; the control group of patients were directly accepted of the radical resection of colorectal cancer. The results showed that in stage III patients, PHRAIC group was significantly better than the control group in 3-year liver metastasis rate (12.7 % vs. 28.3 %, P = 0.001), 3-year tumor-free survival rate (82.3 % vs. 58.7 %, P = 0.0096), overall survival rate (87.7 % vs. 75.7 %, P = 0.002), and median survival time (40.1 vs. 36.3 months, P = 0.03). The preoperative intervention would not increase the incidence of the postoperative complications. These clinical results were published in Annals of Surgery in 2007 (IF=7.678) [17]. For the patients of stage II, there was no significant difference between the two groups.