Safe liver resection following chemotherapy for colorectal metastases is a matter of timing

Abstract

Neoadjuvant chemotherapy (NC) can improve the resectability of hepatic colorectal metastases (CRM). However, there is concern regarding its impact on operative risk. We reviewed 750 consecutive liver resections performed for CRM in a single unit (1996-2005) to evaluate whether NC affected morbidity and mortality. Redo hepatic resections or patients receiving adjuvant chemotherapy following primary resection were excluded. A total of 245 resections were performed in patients not requiring NC (control group) (mean age 63, 67% male) and 252 in patients who had NC (mean age 62, 67% male). The mean (s.d.) duration of surgery was less in the control group (241(64) vs 255(64)min, P=0.014) as was the mean blood loss (390(264) vs 449(424)ml, P=0.069). Postoperative mortality (2 vs 2%) and morbidity (27 vs 29%, P=0.34) was similar between groups. More NC patients developed septic (2.4%) or respiratory (10.3%) complications compared to controls (0 and 5.3%, P<0.03), with significantly more surgical complications if the interval between stopping NC and undergoing surgery was <or=4 weeks (11%), compared to 5-8 (5.5%) or 9-12 (2.6%) weeks (P=0.009). The data suggest that liver resection for CRM is safe following NC. Early hepatobiliary involvement in multidisciplinary cancer care may lead to avoidance of potential perioperative adverse events.

Figure 1

The effect of timing of cessation of chemotherapy on postoperative morbidity. ^*P=0.96, χ² test for trend.

Figure 2

The effect of timing of cessation of chemotherapy on surgical complications. ^*P=0.009, χ² test for trend.

Figure 3

Effect of the duration of chemotherapy on postoperative mortality. ^*P=0.65, χ² test for trend.