Perioperative chemotherapy for resectable colorectal liver metastases: Analysis from the Colorectal Operative Liver Metastases International Collaborative (COLOMIC)

Abstract

Background: Chemotherapy has been increasingly combined with surgery as multimodality treatment for resectable colorectal-liver metastases (CLM). There is paucity of clinical data addressing optimal timing of chemotherapy relative to surgery. We examined outcomes of patients undergoing hepatectomy for resectable CLM.Methods: Seven hundred and eighteen patients treated with hepatectomy for CLM were analyzed from five hepatobiliary institutions between 2000 and 2018. Overall survival (OS) was measured from time of hepatectomy for patients receiving: surgery alone, neoadjuvant, adjuvant, and neoadjuvant-plus-adjuvant (perioperative) chemotherapy. Kaplan-Meier analysis was performed to detect differences in OS between treatment groups. Single-and multi-variable analysis with Cox proportional hazards were run for OS between groups.Results: One hundred and thirty-seven patients (19.08%) received surgery, 104 (14.48%) received neoadjuvant-only, 214 (29.81%) received adjuvant-only, and 263 (36.63%) received perioperative chemotherapy; with median OS of 48.20, 46.83, 56.27, and 49.93 months, respectively. No differences in median OS were seen between groups on Kaplan-Meier analysis. No significant difference in Charlson-Deyo comorbidity status was seen between groups (p = 0.853), while significant difference was seen in maximum tumor size (p = 0.0023). On multivariate analysis, adjuvant (p = 0.010) and perioperative (p = 0.020) chemotherapy were independently associated with OS compared to surgery alone.Discussion: Despite group differences, chemotherapy after surgery was independently associated with improved OS in CLM.

Outcomes after repeat hepatectomy for colorectal liver metastases from the colorectal liver operative metastasis international collaborative (COLOMIC)

“…This is usually an individualized decision—taking into consideration patient comorbidities, general state of health, and patient preferences. We recently found that receiving neoadjuvant‐only chemotherapy before liver resection was not correlated with improved survival compared to surgery alone 35 . In our unmatched populations in this study, a comparable proportion of patients in both groups received chemotherapy after initial hepatectomy, but a significantly greater proportion of patients in the repeat‐hepatectomy group received chemotherapy before initial hepatectomy.…”

“…We recently found that receiving neoadjuvant‐only chemotherapy before liver resection was not correlated with improved survival compared to surgery alone. 35 In our unmatched populations in this study, a comparable proportion of patients in both groups received chemotherapy after initial hepatectomy, but a significantly greater proportion of patients in the repeat‐hepatectomy group received chemotherapy before initial hepatectomy. However, in our PSM analysis, neoadjuvant chemotherapy before first hepatectomy was not correlated with improved survival, suggesting the treatment effect, if any, is modest at best.…”

Metastasis-Directed Local Therapy of Hepatic Oligometastasis from Colorectal Cancer and Future Perspective in Radiation Therapy

“…The surgical resection, however, has been extended along with a few new approaches: conversion therapy, which can shrink the tumor size and potentially convert from unresectable to resectable status; extending resection to extrahepatic disease; two-stage hepatectomy; and portal vein embolization inducing hypertrophy of the future liver remnant, respectively. Furthermore, the outcome of surgical resection of HOCRC could be improved by perioperative administration of chemotherapy [32]. However, there is a high percentage of HOCRC patients in whom complete LC could be attempted but surgery is not regarded a viable option.…”

“…This trial reported the local recurrence rates of 32% and 4% at the site of ablation or resection, respectively (p<0.001) [38]. Several previous studies compared RFA and surgical resection (Table 2), which showed generally inferior local recurrence and OS rates following RFA [27][28][29][30][31][32][33][34][35][36]. Kron et al performed a systematic review of 18 published studies and reported that among the studies, 10 and 8 showed significantly higher local recurrence rates and lower OS and DFS rates in the RFA group than in the surgical resection group, respectively [39].…”