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Extended Preoperative Chemotherapy Does Not Improve Pathologic Response and Increases Postoperative Liver Insufficiency After Hepatic Resection for Colorectal Liver Metastases

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Surgical Oncology, Unit 444, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Yoji Kishi MD, Daria Zorzi MD, Carlo M. Contreras MD, Steven A. Curley MD, Eddie K. Abdalla MD & Jean-Nicolas Vauthey MD

  2. Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Dipen M. Maru MD

  3. Department of Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Scott Kopetz MD

  4. Department of Hepatopancreatobiliary and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy

    Dario Ribero MD & Lorenzo Capussotti MD

  5. Department of Pathology, Ospedale Mauriziano Umberto I, Turin, Italy

    Manuela Motta MD, Nicoletta Ravarino MD & Mauro Risio MD

Authors
  1. Yoji Kishi MD
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  2. Daria Zorzi MD
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  3. Carlo M. Contreras MD
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  4. Dipen M. Maru MD
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  5. Scott Kopetz MD
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  6. Dario Ribero MD
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  7. Manuela Motta MD
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  8. Nicoletta Ravarino MD
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  9. Mauro Risio MD
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  10. Steven A. Curley MD
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  11. Eddie K. Abdalla MD
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  12. Lorenzo Capussotti MD
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  13. Jean-Nicolas Vauthey MD
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Corresponding author

Correspondence to Jean-Nicolas Vauthey MD.

Additional information

Y. Kishi and D. Zorzi contributed equally to the manuscript.

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Kishi, Y., Zorzi, D., Contreras, C.M. et al. Extended Preoperative Chemotherapy Does Not Improve Pathologic Response and Increases Postoperative Liver Insufficiency After Hepatic Resection for Colorectal Liver Metastases. Ann Surg Oncol 17, 2870–2876 (2010). https://doi.org/10.1245/s10434-010-1166-1

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  • DOI: https://doi.org/10.1245/s10434-010-1166-1

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