Question 1: Do I need neoadjuvant therapy routinely for resectable liver metastases? Multiple studies have shown that in resectable CRLM (colorectal liver metastases), neoadjuvant therapy does not contribute to tumor-free survival or overall survival. On the contrary, patients who received neoadjuvant therapy preoperatively had more postoperative complications. Moreover, the EORTC clinical trial found that 7% of patients had tumor progression while receiving neoadjuvant therapy. Therefore, neoadjuvant therapy is not recommended routinely for resectable liver metastases. Question 2: Can regional arterial chemotherapy (HAI) improve chemotherapy response rates and resection rates for colorectal cancer liver metastases (CRLM)? For patients with larger or more hepatic metastases or those who are not sensitive to systemic chemotherapy, HAI has a higher response rate than systemic chemotherapy and can improve the resection rate of CRLM. Question 3: What are the chemotherapy-associated liver injuries? Chemotherapy-associated liver injury includes steatohepatitis (CASH) and hepatic sinusoidal occlusion syndrome (SOS.) CASH is primarily caused by irinotecan and is characterized histologically by hepatic steatosis, lobular inflammation, and vacuolar degeneration of hepatocytes. sOS is primarily caused by oxaliplatin and is characterized histopathologically by central zone hepatocellular edema, anatomic cell lines, and fibrotic hepatic sinusoidal occlusion, resulting in erythrocyte crowding conditions. More severe vascular toxicity includes hemorrhagic lobular central necrosis and regenerative nodular hyperplasia. Question 4: What are some laboratory or imaging findings that may suggest chemotherapy-related liver injury? Some studies have shown that elevated GGT (i.e., glutamyl transpeptidase), decreased platelet count, elevated glutathione-to-platelet ratio, and splenomegaly suggest the presence of hepatic sinusoidal obstruction syndrome (SOS). Question 5: Does preoperative chemotherapy increase complication rates and mortality? The EORTC clinical trial found that 6 cycles of preoperative FOLFOX chemotherapy increased the overall postoperative complication rate from 16% to 25% and the liver-related complication rate from 9% to 15%, but there was no significant change in mortality, and other studies have made similar findings. Overall, preoperative chemotherapy increases the incidence of postoperative complications after hepatectomy, especially in those cases where enlarged hepatectomy is performed, and preoperative chemotherapy often leads to postoperative microhepatic syndrome and fatal liver failure. Question 6: Does chemotherapy have an effect on liver regeneration after portal vein embolization or hepatectomy? The evaluation of the effect of chemotherapy on liver regeneration depends on the time point of evaluation. For 4 weeks or even longer after chemotherapy, imaging evaluation did not show inhibition of liver regeneration. However, it is possible that liver regeneration is affected in a much shorter period of time; therefore, the effect of chemotherapy on liver regeneration must be taken into account when performing chemotherapy in between two-step liver resections or when performing an expanded hepatectomy after chemotherapy. Question 7: How soon after the end of chemotherapy is it appropriate to perform hepatic resection? The timing of surgery is crucial. First of all, it is important to avoid prolonged chemotherapy before surgery, and it is best not to exceed 9 cycles of chemotherapy; generally, it is considered appropriate to perform hepatic resection 4 weeks after the end of chemotherapy.