Progression while receiving preoperative chemotherapy should not be an absolute contraindication to liver resection for colorectal metastases

Luca Viganó, Lorenzo Capussotti, Eduardo Barroso, Gennaro Nuzzo, Christophe Laurent, Jan N M Ijzermans, Jean François Gigot, Joan Figueras, Thomas Gruenberger, Darius F. Mirza, Dominique Elias, Graeme Poston, Christian Letoublon, Helena Isoniemi, Javier Herrera, Francisco Castro Sousa, Fernando Pardo, Valerio Lucidi, Irinel Popescu, René Adam

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Abstract

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<0.0001;14.9 % vs. 7.2 %, p<0.0001), while it was reduced after oxaliplatin (5.6 % vs. 12.0 %, p 3 metastases (p = 0.028), and tumor diameter ≥50 mm (p = 0.002). A survival predictive model showed that patients without any risk factors had 5-year survival rates of 53.3 %; good survival results were still observed if metastases were>3 or ≥50 mm (29.9 and 19.1 %, respectively). On the contrary, survival was less than 10 % at 3 years in the presence of>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.

Original languageEnglish
Pages (from-to)2786-2796
Number of pages11
JournalAnnals of Surgical Oncology
Volume19
Issue number9
DOIs
Publication statusPublished - Sep 2012

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    Viganó, L., Capussotti, L., Barroso, E., Nuzzo, G., Laurent, C., Ijzermans, J. N. M., Gigot, J. F., Figueras, J., Gruenberger, T., Mirza, D. F., Elias, D., Poston, G., Letoublon, C., Isoniemi, H., Herrera, J., Sousa, F. C., Pardo, F., Lucidi, V., Popescu, I., & Adam, R. (2012). Progression while receiving preoperative chemotherapy should not be an absolute contraindication to liver resection for colorectal metastases. Annals of Surgical Oncology, 19(9), 2786-2796. https://doi.org/10.1245/s10434-012-2382-7