International Journal of Colorectal Disease

, Volume 27, Issue 5, pp 635–645

Impact of preoperative targeted therapy on postoperative complications after resection of colorectal liver metastases

  • Hannes P. Neeff
  • Oliver Drognitz
  • Andrea Klock
  • Gerald Illerhaus
  • Oliver G. Opitz
  • Ulrich T. Hopt
  • Frank Makowiec
Original Article

DOI: 10.1007/s00384-011-1360-z

Cite this article as:
Neeff, H.P., Drognitz, O., Klock, A. et al. Int J Colorectal Dis (2012) 27: 635. doi:10.1007/s00384-011-1360-z

Abstract

Purpose

The impact of chemotherapy (CTx) on morbidity after liver resection for colorectal metastases (CRC-LM) has been increasingly investigated during recent years. Biologic agents like bevacizumab (BEV) or cetuximab (CET) are now added as “targeted therapy” (TT), also in neoadjuvant settings. Initial series could demonstrate the safety of those regimens in liver resection but data are still scarce. We evaluated the impact of CTx with BEV or CET (CTx + TT) on perioperative morbidity and mortality.

Methods

Two hundred thirty-seven patients who underwent liver resections for CRC-LM after chemotherapy before surgery since 1999 were included. One hundred eighty-five patients (78%) had preoperative CTx regimen without biologic agents (fluoropyrimidine-, oxaliplatin-, or irinotecan-based) and 52 (22%) had CTx + TT (39 BEV, 11 CET, 2 CET/BEV). After preoperative CTx + TT, a time interval of at least 4–6 weeks and a residual liver volume of >35% before surgery were required.

Results

Hemihepatectomy or more was performed in about half of the patients. The median amount of intraoperatively transfused blood was 0 ml in both groups (p = 0.34). Overall mortality was 1.7% and slightly elevated in patients with CTx + TT (3.8% vs. 1.1%, p = 0.17). Any complication occurred in (CTx + TT vs. CTx) 52% and 46%, respectively (p = 0.47). The rates of liver failure (9.6% vs. 9.7%, p = 0.98), infectious complications such as wound infection (19% vs. 16%, p = 0.62) and abdominal abscess (8% vs. 6.5%, p = 0.71), as well as the rate of relaparotomies (11.5% vs. 7.0%, p = 0.29) showed no significant differences between the groups with TT or without. In multivariate analyses, neither type nor duration of CTx nor the time interval between CTx and surgery showed any influence on complication rates.

Conclusions

Our data confirm the safety of targeted therapy before liver resection for CRC-LM. This effect may in part be due to our treatment policy (time interval to resection and residual liver volume) after intensive preoperative CTx.

Keywords

Colorectal cancer Liver metastasis Chemotherapy Surgery Complications 

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Hannes P. Neeff
    • 1
  • Oliver Drognitz
    • 1
  • Andrea Klock
    • 1
  • Gerald Illerhaus
    • 2
    • 3
  • Oliver G. Opitz
    • 3
  • Ulrich T. Hopt
    • 1
    • 3
  • Frank Makowiec
    • 1
    • 3
  1. 1.Department of SurgeryUniversity of FreiburgFreiburgGermany
  2. 2.Department of Hematology and OncologyUniversity of FreiburgFreiburgGermany
  3. 3.Comprehensive Cancer CenterUniversity of FreiburgFreiburgGermany

Personalised recommendations