Progression while Receiving Preoperative Chemotherapy Should Not Be an Absolute Contraindication to Liver Resection for Colorectal Metastases

• Published in: Annals of surgical oncology 2012-09, Vol.19 (9), p.2786-2796
• Main Authors: Viganò, Luca, Capussotti, Lorenzo, Barroso, Eduardo, Nuzzo, Gennaro, Laurent, Christophe, Ijzermans, Jan N. M., Gigot, Jean-François, Figueras, Joan, Gruenberger, Thomas, Mirza, Darius F., Elias, Dominique, Poston, Graeme, Letoublon, Christian, Isoniemi, Helena, Herrera, Javier, Castro Sousa, Francisco, Pardo, Fernando, Lucidi, Valerio, Popescu, Irinel, Adam, René
• Format: Article
• Language: English
• Subjects: Aged; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Humanized - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bevacizumab; Camptothecin - administration & dosage; Camptothecin - analogs & derivatives; Carcinoembryonic Antigen - blood; Cetuximab; Colorectal Neoplasms - blood; Colorectal Neoplasms - pathology; Contraindications; Disease Progression; Disease-Free Survival; Female; Fluorouracil - administration & dosage; Hepatectomy; Hepatobiliary Tumors; Humans; Kaplan-Meier Estimate; Liver Neoplasms - drug therapy; Liver Neoplasms - pathology; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Multivariate Analysis; Neoadjuvant Therapy; Oncology; Organoplatinum Compounds - administration & dosage; Proportional Hazards Models; Retrospective Studies; Risk Factors; Surgery; Surgical Oncology; Survival Rate; Tumor Burden
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-012-2382-7

Purpose Tumor progression while receiving neoadjuvant chemotherapy (PD) has been associated with poor outcome and is commonly considered a contraindication to liver resection (LR). This study aims to clarify in a large multicenter setting whether PD is always a contraindication to LR. Methods Data from the LiverMetSurvey international registry were analyzed. Patients undergoing LR for colorectal metastases without extrahepatic disease after neoadjuvant chemotherapy between 1990 and 2009 were reviewed. Results Among 2143 patients, PD occurred in 176 (8.2 %). Risk of progression was increased after 5-FU or irinotecan (22.7 % vs. 6.8 % after other regimens, p  1 prognostic factor or CEA of ≥200 ng/mL. Conclusions PD is a negative prognostic factor, but it is not an absolute contraindication to LR. Patients with PD could be scheduled for LR except for those with >3 metastases and ≥50 mm, or CEA ≥200 ng/mL in whom further chemotherapy is recommended.