Chemotherapy for colorectal cancer prior to liver resection for colorectal cancer hepatic metastases does not adversely affect peri-operative outcomes

• Published in: Journal of surgical oncology 2007-01, Vol.95 (1), p.22-27
• Main Authors: Sahajpal, Ajay, Vollmer Jr, Charles M., Dixon, Elijah, Chan, Elisa K., Wei, Alice, Cattral, Mark S., Taylor, Bryce R., Grant, David R., Greig, Paul D., Gallinger, Steven
• Format: Article
• Language: English
• Subjects: 5-FU/leucovorin; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Camptothecin - administration & dosage; Camptothecin - analogs & derivatives; Chemotherapy, Adjuvant; Cohort Studies; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - pathology; Drug Administration Schedule; Fatty Liver - etiology; Female; Fluorouracil - administration & dosage; Hepatectomy; Humans; irinotecan; Leucovorin - administration & dosage; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; metastasectomy; Middle Aged; neoadjuvant chemotherapy; Neoplasm Staging; Preoperative Care; Retrospective Studies; Treatment Outcome
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.20632

Background Systemic chemotherapy is being used increasingly in patients with colorectal cancer. The effects of prior systemic adjuvant or palliative chemotherapy on morbidity following hepatic resection for metastases are not well defined. Objectives To assess the peri‐operative impact of systemic chemotherapy on liver resection for colorectal cancer hepatic metastases. Methods Ninety‐six resections for colorectal cancer hepatic metastases performed from July 2001 to July 2003 (93% ≥2 segments) were reviewed. Pre‐operative demographics, peri‐operative features, and post‐operative outcomes were collected prospectively. Type of chemotherapy and the temporal relationship of chemotherapy to the liver resection were analyzed. Results Fifty‐three of 96 patients (55%) received a mean of 5.7 cycles (6.1 months) of systemic chemotherapy prior to hepatic resection, with a median interval of 12 months from end of chemotherapy to liver resection (range 1–75 months). Thirty‐five received 5‐fluorouracil/leucovorin (5‐FU/LV) alone, nine had irinotecan (CPT‐11) in addition to 5‐FU/LV, and nine were not specified. Pre‐operative age, sex, co‐morbidities, ASA score, biochemical and liver enzyme profiles, tumor number, and extent and technique of hepatic resection were the same in the chemotherapy and non‐chemotherapy cohorts. Mean tumor size was smaller (4.5 cm vs. 5.8 cm) and synchronous metastases were half as common (25% vs. 49%) in the chemotherapy group. Liver resection operative time was equivalent (270 min) in the two groups. Higher estimated blood loss (EBL) (1,000 ml vs. 850 ml), but fewer transfusions (23% vs. 15%) were associated with the chemotherapy group. Although not statistically significant, post‐operative liver enzyme peaks were higher in the chemotherapy group (AST = 402 U/L vs. 302 U/L, P = 0.09 and ALT = 433 U/L vs. 312 U/L, P = 0.1). Peak changes in INR and serum bilirubin did not differ. Complications and length of stay (LOS) did not differ between the groups. The only post‐operative death was in the non‐chemotherapy group. Interestingly, hepatic steatosis was present in 28% of the non‐chemotherapy cases and 57% of the chemotherapy resection specimens (P = 0.005) and was marked (>30%) in 7% and 10%, respectively. Further analysis of the chemotherapy group based on the interval between completion of chemotherapy and the hepatic resection (2 years) revealed a trend towards worse outcomes in most categories for thos