Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases

L. Capussotti, A. Muratore, M. M. Mulas, P. Massucco, M. Aglietta

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Background: Hepatic surgery is the treatment of choice for resectable colorectal liver metastases. Neoadjuvant chemotherapy can downstage the tumour and enable surgery in up to 38 per cent of patients whose tumours were initially considered irresectable. Methods: This prospective study included 150 patients who underwent hepatic resection over a 4-year period. One hundred and sixteen patients had resection without neoadjuvant chemotherapy (group 1) and 34 had chemotherapy before liver surgery (group 2). Perioperative features, survival and pattern of recurrence were compared. Results: Median follow-up was 35.1 months. The in-hospital mortality rate was zero. Three-year overall survival in the two groups was comparable (P = 0.232). The 3-year disease-free survival rate was 21 per cent in the neoadjuvant group compared with 50.5 per cent in the immediate resection group (P <0.001). Recurrence rates were 94 percent (32 of 34) in group 1 and 66.4 per cent in group 2 (P = 0.001); extrahepatic recurrence, alone or associated with recurrence in the liver, was significantly more common in group 2 than in group 1 (78 versus 55 per cent; P = 0.016). Multivariate analysis revealed that resection of the recurrence was the most important independent prognostic factor for improved disease-free survival (relative risk 0.2; P <0.001). Patients in group 2 had reduced disease-free survival (RR 1.8; P = 0.012). Conclusion: The recurrence rate among patients who had neoadjuvant chemotherapy and surgery for initially irresectable liver metastases was extremely high. Re-resection should be attempted whenever feasible.

Original languageEnglish
Pages (from-to)1001-1006
Number of pages6
JournalBritish Journal of Surgery
Volume93
Issue number8
DOIs
Publication statusPublished - Aug 2006

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Neoplasm Metastasis
Recurrence
Drug Therapy
Liver
Disease-Free Survival
Survival
Hospital Mortality
Neoplasms
Multivariate Analysis
Survival Rate
Prospective Studies
Mortality
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. / Capussotti, L.; Muratore, A.; Mulas, M. M.; Massucco, P.; Aglietta, M.

In: British Journal of Surgery, Vol. 93, No. 8, 08.2006, p. 1001-1006.

Research output: Contribution to journalArticle

Capussotti, L. ; Muratore, A. ; Mulas, M. M. ; Massucco, P. ; Aglietta, M. / Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. In: British Journal of Surgery. 2006 ; Vol. 93, No. 8. pp. 1001-1006.
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