Extended preoperative chemotherapy does not improve pathologic response and increases postoperative liver insufficiency after hepatic resection for colorectal liver metastases

Yoji Kishi, Daria Zorzi, Carlo M. Contreras, Dipen M. Maru, Scott Kopetz, Dario Ribero, Manuela Motta, Nicoletta Ravarino, Mauro Risio, Steven A. Curley, Eddie K. Abdalla, Lorenzo Capussotti, Jean Nicolas Vauthey

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Abstract

Background: The optimal duration, safety, and benefit of preoperative chemotherapy in patients with colorectal liver metastases (CLM) are unclear. We evaluated the association between the duration of preoperative chemotherapy with 5-fluorouracil (5-FU), leucovorin, oxaliplatin (FOLFOX) ± bevacizumab, pathologic response, and hepatotoxicity after hepatic resection for CLM. Methods: A total of 219 patients underwent hepatic resection following FOLFOX with or without bevacizumab and were divided into 2 groups according to the chemotherapy duration: 1-8 cycles (short duration [SD]; N = 157) and ≥ 9 cycles (long duration [LD]; N = 62). The frequency of complete or major pathologic response, sinusoidal injury, and major postoperative morbidity were compared. Results: Treatment consisting of ≥9 cycles was not associated with an increase in complete or major pathologic response (SD vs. LD, 57% vs. 55%; P = .74). The incidence of sinusoidal injury was higher in the LD group (26% vs. 42%; P = .017). The incidence of liver insufficiency was higher in the LD group (4% vs. 11%; P = .035). Sinusoidal injury did not predict postoperative liver insufficiency; multivariate analysis revealed ≥ 9 cycles was the only independent predictor of postoperative liver insufficiency (P = .031; odds ratio = 3.90). Chemotherapy including bevacizumab was associated with a significantly higher frequency of complete or major response in both SD and LD groups. Conclusions: Extended preoperative chemotherapy increases the risk of hepatotoxicity in CLM without improving the pathologic response. The type of chemotherapy (FOLFOX with bevacizumab) has more impact on pathologic response than the duration of chemotherapy.

Original languageEnglish
Pages (from-to)2870-2876
Number of pages7
JournalAnnals of Surgical Oncology
Volume17
Issue number11
DOIs
Publication statusPublished - Nov 2010

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ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Kishi, Y., Zorzi, D., Contreras, C. M., Maru, D. M., Kopetz, S., Ribero, D., Motta, M., Ravarino, N., Risio, M., Curley, S. A., Abdalla, E. K., Capussotti, L., & Vauthey, J. N. (2010). Extended preoperative chemotherapy does not improve pathologic response and increases postoperative liver insufficiency after hepatic resection for colorectal liver metastases. Annals of Surgical Oncology, 17(11), 2870-2876. https://doi.org/10.1245/s10434-010-1166-1