Peri‐operative chemotherapy for resectable colorectal liver metastasis: Does timing of systemic therapy matter?

Abstract

BACKGROUND: The benefit of pre-operative chemotherapy in patients with resectable colorectal liver metastases (CRLM) remains ill defined. We sought to evaluate the impact of peri-operative systemic chemotherapy timing on outcome following resection of CRLM. METHODS: 676 patients who underwent surgery for CRLM were identified from two hepatobiliary center databases. Data were collected and analyzed utilizing multivariate, matched, and propensity-score analyses. RESULTS: Median number of metastases was 2 and median tumor size was 3.3 cm. 334 patients (49.4%) received pre-operative chemotherapy while 342(50.6%) did not. Surgical treatment was resection only (n = 555; 82.1%; minor hepatectomy, n = 399; 59.1%). While there was no difference in morbidity following minor liver resection (pre-operative chemotherapy: 17.9% versus no pre-operative chemotherapy: 16.5%; P = 0.72), morbidity was higher after major hepatic resection (pre-operative chemotherapy: 23.1% versus no pre-operative chemotherapy: 14.2%; P = 0.06). Patients treated with pre-operative chemotherapy had worse 5-year survival (43%) as compared to patients not treated with pre-operative chemotherapy (55%)(P = 0.009). Controlling for baseline characteristics, pre-operative chemotherapy was not associated with outcome on multivariate (HR = 1.04, P = 0.87) or propensity-score analysis (HR = 1.40, P = 0.12). CONCLUSION: Pre-operative chemotherapy was associated with a trend toward increased morbidity among patients undergoing a major hepatic resection. Receipt of pre-operative chemotherapy was associated with neither an advantage nor disadvantage in terms of long-term survival.