Preoperative Chemotherapy Does Not Increase Morbidity or Mortality of Hepatic Resection for Colorectal Cancer Metastases

Abstract

Hepatic metastasis from colorectal cancer (mCRC) is best treated with a multidisciplinary approach. Conflicting data exist regarding the impact of preoperative chemotherapy on morbidity and mortality after hepatectomy. We hypothesized that preoperative chemotherapy does not adversely impact complications or mortality associated with hepatectomy. A retrospective analysis was performed and included patients with mCRC who underwent hepatectomy from 1996 to 2006. Patients were separated into two groups: those who received preoperative chemotherapy and those who did not. Univariate and multivariate analyses were performed to determine the factors associated with morbidity and mortality. Kaplan-Meier analyses were performed to determine disease-free survival (DFS) and overall survival (OS). One hundred eighty-six patients were analyzed: 112 (60%) received preoperative chemotherapy for a median of 4.2 months. Eighty patients (43%) underwent major hepatectomy. When comparing the two groups, there were no differences in hepatic tumor size (median 3 cm; p = 0.35), type of resection (p = 0.62), stage (p = 0.44) or location (p = 0.10) of the primary tumor, preoperative carcinoembryonic antigen (CEA) level (p = 0.80), or number of nodes in lymphadenectomy (p = 0.62). Only number of positive nodes after colectomy (p = 0.02), age (p < or = 0.0001), and combined resection/radiofrequency ablation (RFA) (p = 0.004) were statistically different between the two groups. There was no difference in rates of morbidity (p = 0.81), mortality (p = 0.29), DFS (p = 0.25) or OS (p = 0.30). We conclude that the use of preoperative chemotherapy did not increase the risk of complications or death for patients undergoing hepatectomy for metastatic colorectal cancer. Pre-hepatectomy chemotherapy appears to be safe and is an important part of the multidisciplinary approach for this disease.

Prognostic factors for survival in patients with colorectal liver metastases: experience of a single brazilian cancer center

“…In this sample of patients, estimated 5-year overall survival was 64.9%, a higher result than that found in other principal studies so far (4,11,12,21) . This can be explained by the relatively short median follow-up time (29 months) and the extremely rigorous selection of patients submitted to surgical resection, especially in the 1st years of the study.…”

Targeted molecular therapies (cetuximab and bevacizumab) do not induce additional hepatotoxicity: Preliminary results of a case–control study

“…In particular, no patient developed hepatic failure. In the literature, several studies reported no increase of morbidity and mortality after preoperative chemotherapy (24)(25)(26). In the series of Aloia et al (5), patients who had received more than 12 cycles of preoperative chemotherapy had higher risk of reoperation and a longer hospital stay.…”

Designing Liver Resections and Pushing the Envelope with Resections for Hepatic Colorectal Metastases

“…The multidisciplinary team must determine whether a margin-negative resection is achievable and that an adequate amount of liver with intact vascular inflow and outflow and biliary drainage will remain post-resection in order to prevent post-operative hepatic failure. The volume of liver parenchyma that will remain after resection, i.e., the future liver remnant (FLR), is of paramount importance in hepatic resections [11][12][13]. Conventionally 20 % of the total liver volume has been regarded as the minimum safe FLR in a patient with normal hepatic function [7]; however, an FLR of 30-40 % is necessary if the patient has received cytotoxic chemotherapy, since chemotherapeutic agents used to treat CRC cause hepatic injury, such as steatosis and sinusoidal obstruction with oxaliplatin and steatohepatitis with irinotecan [12,14].…”