Preoperative chemotherapy and the outcome of liver resection for colorectal metastases

J C Hewes, S Dighe, R W Morris, R R Hutchins, S Bhattacharya, B R Davidson

Research output: Contribution to journalArticle (Academic Journal)peer-review

42 Citations (Scopus)

Abstract

Backgrouind: Neoadjuvant systemic chemotherapy is being increasingly used prior to liver resection for colorectal metastases. Oxaliplatin has been implicated in causing structural changes to the liver parenchyma, and such changes may increase the morbidity and mortality of surgery.

Patients and Methods: A retrospective study was undertaken of 101 consecutive patients who had undergone liver resection for colorectal metastases in two HPB centers. Preoperative demographic and premorbid data were gathered along with liver function tests and tumor markers. A subjective assessment of the surgical procedure was noted, and in-hospital morbidity and mortality were calculated. The effect of preoperative chemotherapy on short-term and long-term outcome was analyzed, and actuarial 1 and 3 year survival was determined.

Results: Patients who received neoadjuvant chemotherapy had a higher number of metastases (median 2, range 1-8 versus median 1, range 1-5; P = 0.019) and more had synchronous tumors (24 patients versus 8; P <0.001). Overall morbidity was 37% and hospital mortality was 3.9%. Operative and in-hospital outcome was not influenced by chemotherapy. Long-term survival was worse in patients who had received preoperative chemotherapy (actuarial 3-year survival 62% versus 80%; P = 0.04).

Conlcusions: This study shows no evidence that neoadjuvant chemotherapy, and in particular oxaliplatin, increases the risk associated with liver resection for colorectal metastases. Long-term outcome is reduced in patients receiving preoperative chemotherapy, although they have more advanced disease.

Original languageEnglish
Pages (from-to)353-64; discussion 365-6
Number of pages14
JournalWorld Journal of Surgery
Volume31
Issue number2
DOIs
Publication statusPublished - Feb 2007

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents
  • Chemotherapy, Adjuvant
  • Cohort Studies
  • Colorectal Neoplasms
  • Drug Administration Schedule
  • Female
  • Hepatectomy
  • Humans
  • Liver Neoplasms
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Retrospective Studies
  • Treatment Outcome

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