Potential indications for neoadjuvant chemotherapy include one or more of the following: Multiple liver metastases Lymphadenopathy in the porta hepatis Suprarenal para-aortic lymph nodes Diffuse mesenteric disease Evidence of pleural or parenchymal lung disease In a large randomized trial, neoadjuvant chemotherapy followed by surgery had less perioperative morbidity than primary surgery followed by chemotherapy and similar long-term survival rates (1).