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Neoadjuvant Chemotherapy Versus Upfront Surgery for Resectable Liver Metastases from Colorectal Cancer: a Multicenter, Propensity Score–Matched Cohort Study

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Adjuvant chemotherapy for resectable colorectal liver metastasis (CRLM) is widely used, but its efficacy lacks clear evidence. This retrospective cohort study investigated the effectiveness of neoadjuvant chemotherapy (NAC) compared to upfront surgery for CRLM.

Methods

Data from patients with resectable CRLM were analyzed. Short-term outcomes and long-term prognosis were analyzed using propensity score matching. CRLM was stratified according to the H-classification (H1 and H2), and the effectiveness of adjuvant chemotherapy was analyzed in each group.

Results

We analyzed 599 cases that were matched into an NAC group (n = 136) and an upfront surgery group (n = 136). The proportion of synchronous metastases, H2-classification, and postoperative chemotherapy rate did not differ between the groups. Overall survival (OS) after initial treatment was significantly worse in the NAC group than in the upfront surgery group (P = 0.029). The 5-, 7-, and 10-year OS rates for H1 patients were significantly better in the upfront surgery group than in the NAC group (64%, 51%, and 44% vs. 50%, 31%, and 18%, respectively) (P = 0.004).

Conclusion

Patients with resectable CRLM should undergo upfront surgery, because NAC did not improve OS after initial treatment in these patients.

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Abbreviations

CRLM:

Colorectal liver metastasis

NAC:

Neoadjuvant chemotherapy

OS:

Overall survival

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan

    Fumitoshi Hirokawa, Koji Komeda & Kazuhisa Uchiyama

  2. Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

    Masaki Ueno & Shinya Hayami

  3. Department of Surgery, Faculty of Medicine, Kinki University, Osaka-Sayama, Japan

    Takuya Nakai

  4. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan

    Masaki Kaibori & Hisashi Kosaka

  5. Department of Surgery, Nara Medical University, Kashihara, Japan

    Takeo Nomi & Daisuke Hokuto

  6. Department of Surgery, Shiga University of Medical Science, Otsu, Japan

    Hiroya Iida

  7. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan

    Shogo Tanaka & Shoji Kubo

Authors
  1. Fumitoshi Hirokawa
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  2. Masaki Ueno
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  13. Kazuhisa Uchiyama
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Corresponding author

Correspondence to Fumitoshi Hirokawa.

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Ethics Approval

This cohort study and the associated protocol are not registered with UMIN or ClinicalTrials.gov but were approved by the Ethics Committee of each institution (approval number: 2734; Osaka Medical College).

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The authors declare no competing interest.

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Synopsis: Unplanned NAC exacerbated rather than improved overall survival after initial treatment in resectable liver metastasis from colorectal cancer (CRLM).

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Hirokawa, F., Ueno, M., Nakai, T. et al. Neoadjuvant Chemotherapy Versus Upfront Surgery for Resectable Liver Metastases from Colorectal Cancer: a Multicenter, Propensity Score–Matched Cohort Study. J Gastrointest Surg 26, 772–781 (2022). https://doi.org/10.1007/s11605-021-05175-y

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  • DOI: https://doi.org/10.1007/s11605-021-05175-y

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