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Preoperative Chemotherapy and the Outcome of Liver Resection for Colorectal Metastases

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Abstract

Background

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).

Conclusions

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.

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Authors and Affiliations

  1. Department of HPB and Liver Transplant Surgery, University Department of Surgery, Academic Division of Surgical Specialties, The Royal Free Hospital and Royal Free campus, Royal Free and University College School of Medicine, UCL, London, United Kingdom, NW3 2QG

    J. C. Hewes MD, S. Dighe MBBS & B. R. Davidson MD

  2. Department of Primary Care and Population Sciences, Royal Free Hospital and Royal Free and University College Medical School, UCL, London, United Kingdom, NW3 2QG

    R. W. Morris MD

  3. Department of Hepatobiliary and Pancreatic Surgery, Barts and the London NHS Trust, Whitechapel Road, London, United Kingdom, E1 1BB

    R. R. Hutchins MD & S. Bhattacharya MD

Authors
  1. J. C. Hewes MD
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  2. S. Dighe MBBS
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  3. R. W. Morris MD
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  4. R. R. Hutchins MD
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  5. S. Bhattacharya MD
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  6. B. R. Davidson MD
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Correspondence to B. R. Davidson MD.

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Hewes, J.C., Dighe, S., Morris, R.W. et al. Preoperative Chemotherapy and the Outcome of Liver Resection for Colorectal Metastases. World J. Surg. 31, 353–364 (2007). https://doi.org/10.1007/s00268-006-0103-8

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  • DOI: https://doi.org/10.1007/s00268-006-0103-8

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