Skip to main content
SpringerLink
Log in

Is There a Survival Benefit to Neoadjuvant Versus Adjuvant Chemotherapy, Combined with Surgery for Resectable Colorectal Liver Metastases?

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The benefits of adding chemotherapy to surgery in patients with hepatic colorectal metastases at moderate and high risk for recurrence and the optimal sequence of administration are undetermined.

Methods

We followed the overall-survival and event-free survival rates after operation in patients with resectable colorectal metastases confined to the liver. The adjuvant patients first underwent surgery and then treatment, whereas the neoadjuvant patients underwent treatment, surgery, and re-treatment. Assignment was by oncologist and patient preferences. Chemotherapy was oxaliplatin (FOLFOX) or irinotecan (FOLFIRI) based.

Results

Fifty-six of 105 patients who underwent liver resections for colorectal metastases (2002–2005) are included. The two groups were comparable for demographics, characteristics of disease (including recurrence risk), treatment protocols, and follow-up. The respective 1-, 2-, and 3-year overall survival rates were 91%, 91%, and 84%, and the event-free survival rates were 63%, 49%, and 49% for the 19 adjuvant patients, and 95%, 91%, and 70%, and 94%, 50%, and 50% for the 37 neoadjuvant patients.

Conclusions

The midterm overall survival and disease-free survival rates in this group of patients with resectable colorectal metastases to the liver, who were treated with combination of resection and chemotherapy, were similar, regardless of the sequence of treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Fortner JG, Silva JS, Golbey RB et al (1984) Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. 1. Treatment by hepatic resection. Ann Surg 199:306–316

    Article  PubMed  CAS  Google Scholar 

  2. Adson MA, Van Heerden JA, Adson MH et al (1984) Resection of hepatic metastases from colorectal cancer. Arch Surg 11:647–651

    Google Scholar 

  3. Hughes KS, Simon R, Songhourabodi S et al (1986) Resection of the liver for colorectal carcinoma metastases: a multi institutional study of patterns of recurrence. Surgery 100:278–284

    PubMed  CAS  Google Scholar 

  4. Scheele J, Stangl R, Altendorf-Hofmann A (1985) Resection of colorectal liver metastases. World J Surg 19:59–71

    Article  Google Scholar 

  5. Scheele J, Stangl R, Altendorf-Hofmann A et al (1991) Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 110:13–29

    PubMed  CAS  Google Scholar 

  6. Lorenz M, Muller H, Schramm H et al (1998) Randomized trial of surgery versus surgery followed by adjuvant hepatic arterial infusion with 5-FU and folinic acid for liver metastases of colorectal cancer. German Cooperative on Liver Metastases (Arbeitsgruppe Lebermetastasen) Ann Surg 228:756–762

    PubMed  CAS  Google Scholar 

  7. Kemeny H, Huang Y, Cohen AM et al (1999) Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med 341:2039–2048

    Article  PubMed  CAS  Google Scholar 

  8. Kemeny M, Adak S, Gray B et al (2002) Combined-modality treatment for resectable metastatic colorectal carcinoma of the liver: surgical resection of hepatic metastases in combination with continuous infusion of chemotherapy—an intergroup study. J Clin Oncol 20:1499–1505

    Article  PubMed  Google Scholar 

  9. Wein A, Riedel C, Kockerling F et al (2001) Impact of surgery on survival in palliative patients with metastatic colorectal cancer after first line treatment with weekly 24-h infusion of high doses of 5-FU and folinic acid. Ann Oncol 12:1721–1727

    Article  PubMed  CAS  Google Scholar 

  10. Giachetti S, Itzhaki M, Gruia G et al (1999) Long term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-FU, leucovorin, oxaliplatin and surgery. Ann Oncol 10:663–669

    Article  Google Scholar 

  11. Bismuth H, Adam R, Levi F et al (1996) Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg 224:509–522

    Article  PubMed  CAS  Google Scholar 

  12. Wein A, Riedel C, Bruckl W et al (2003) Neoadjuvant treatment with weekly high dose 5-FU as 24 hour infusion, folinic acid and oxaliplatin in patients with primarily resectable liver metastases of colorectal cancer. Oncology 64:131–138

    Article  PubMed  CAS  Google Scholar 

  13. Tanaka K, Adam R, Shimada H et al (2003) Role of neoadjuvant chemotherapy in the treatment of multiple colorectal metastases to the liver. Br J Surg 90:963–969

    Article  PubMed  CAS  Google Scholar 

  14. Allen P, Kemeny N, Jarnagin W et al (2003) Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases. J Gastrointest Surg 7:109–117

    Article  PubMed  Google Scholar 

  15. Vitola JV, Delbeke D, Sandler MP et al (1996) Positron emission tomography to stage suspected metastatic colorectal carcinoma to the liver. Am J Surg 171:21–26

    Article  PubMed  CAS  Google Scholar 

  16. Flamen P, Stroobants S, Van-Cutsem E et al (1999) Additional value of whole-body PET with fluorine-18-2fluoro-2-deoxy-D-glucose in recurrent colorectal cancer. J Clin Oncol 17:894–901

    PubMed  CAS  Google Scholar 

  17. Fernandez F, Drebin JA, Linehan DC et al (2004) Five year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg 240:438–450

    Article  PubMed  Google Scholar 

  18. Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer. Ann Surg 230:309–321

    Article  PubMed  CAS  Google Scholar 

  19. De Gramont A, Figer A, Seymour M et al (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18:2938–2947

    PubMed  Google Scholar 

  20. Arru M, Aldrighetti L, Castoldi R et al (2008) Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer. World J Surg 31:93–103

    Article  Google Scholar 

  21. Rees M, Tekkis PP, Welsh FK et al (2008) Evaluation of long term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg 247:125–135

    Article  PubMed  Google Scholar 

  22. Vigano L, Ferrero A, Lo Tesoriere R et al (2008) Liver surgery for colorectal metastases: results after 10 years of follow-up. Long-term survivors, late recurrences, and prognostic role of morbidity. Ann Surg Oncol 15:2458–2464

    Article  PubMed  Google Scholar 

  23. Andre T, Louvet C, Maindrault-Goebel F et al (1999) CPT-11 (irinotecan) addition to bimonthly, high-dose leucovorin and bolus and continuous-infusion 5-fluorouracil (FOLFIRI) for pretreated metastatic colorectal cancer. GERCOR. Eur J Cancer 35:1343–1347

    Article  CAS  Google Scholar 

  24. Fong Y, Bentrem DJ (2006) CASH (chemotherapy-associated steatohepatitis) costs. Ann Surg 243:8–9

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The authors are grateful to Esther Eshkol editorial assistance.

Author information

Authors and Affiliations

  1. Department of Surgery “B”, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel-Aviv, 64239, Israel

    Nir Lubezky, Richard Nakache, Joseph M. Klausner & Menahem Ben-Haim

  2. Liver Surgery Unit, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel-Aviv, 64239, Israel

    Richard Nakache & Menahem Ben-Haim

  3. Service for Gastrointestinal Malignancies, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel-Aviv, 64239, Israel

    Ravit Geva, Einat Shmueli & Arie Figer

Authors
  1. Nir Lubezky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ravit Geva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Einat Shmueli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard Nakache
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joseph M. Klausner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arie Figer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Menahem Ben-Haim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Menahem Ben-Haim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lubezky, N., Geva, R., Shmueli, E. et al. Is There a Survival Benefit to Neoadjuvant Versus Adjuvant Chemotherapy, Combined with Surgery for Resectable Colorectal Liver Metastases?. World J Surg 33, 1028–1034 (2009). https://doi.org/10.1007/s00268-009-9945-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-009-9945-1

Keywords

Search

Navigation