Safety and Outcomes Following Resection of Colorectal Liver Metastases in the Era of Current Perioperative Chemotherapy

Ilia Gur, Brian S. Diggs, Jesse A. Wagner, Gina Vaccaro, Charles Lopez, Brett Sheppard, Susan Orloff, Kevin Billingsley

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Preoperative chemotherapy is increasingly utilized in the treatment of colorectal liver metastases (CRLM). Although this strategy may improve resectability, long-term advantages of preoperative chemotherapy for resectable CRLM are less clear. The objective of this study is to report safety and outcomes when perioperative chemotherapy is routinely added to surgery for CRLM. Methods: A retrospective review of patients undergoing liver resections for CRLM during 2003-2011 in single academic oncology center. Demographic data, tumor characteristics, chemotherapy, surgical details, complications and survival were analyzed. Results: The study included 157 patients that underwent 168 liver operations. One hundred eighteen patients (70 %) underwent preoperative chemotherapy (75 % oxaliplatin-based). Preoperative portal vein embolization was utilized in 16 (10.1 %) patients. Overall survival (OS) was 89, 57, and 27 % at 1, 3, and 5 years, respectively (median survival-42.8 months). Eleven (7 %) patients had repeat resections for liver recurrence. Thirty-day mortality was 1.26 %, morbidity-24 % (6 %-liver related). Complications were not significantly different in patients that had preoperative chemotherapy. On a multivariate analysis advanced age and >3 lesions predicted poor OS, while advanced age, lesions >5 cm, synchronous lesions, margin-positivity and resection less than hepatectomy were associated with decreased DFS. Conclusions: Our results suggest that even with chemotherapy and resection only a subset of patients remain disease-free after 5 years. However, even in a high-risk patient with multiple lesions, preoperative chemotherapy can be administered safely without apparent increase in postoperative complications. Perioperative chemotherapy should be considered particularly in patients with multifocal or large lesions, synchronous disease and short disease-free interval.

Original languageEnglish (US)
Pages (from-to)2133-2142
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume17
Issue number12
DOIs
StatePublished - Dec 2013

Fingerprint

Neoplasm Metastasis
Safety
Drug Therapy
Liver
oxaliplatin
Survival
Colorectal Surgery
Hepatectomy
Portal Vein
Multivariate Analysis
Demography
Morbidity
Recurrence
Mortality
Neoplasms

Keywords

  • Chemotherapy
  • Colorectal cancer
  • Colorectal liver metastases
  • FOLFOX
  • Liver resection
  • Outcomes
  • Portal vein embolization
  • Repeat resections

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

@article{b1cd22dadb044c79927d98c6776eaa9d,
title = "Safety and Outcomes Following Resection of Colorectal Liver Metastases in the Era of Current Perioperative Chemotherapy",
abstract = "Background: Preoperative chemotherapy is increasingly utilized in the treatment of colorectal liver metastases (CRLM). Although this strategy may improve resectability, long-term advantages of preoperative chemotherapy for resectable CRLM are less clear. The objective of this study is to report safety and outcomes when perioperative chemotherapy is routinely added to surgery for CRLM. Methods: A retrospective review of patients undergoing liver resections for CRLM during 2003-2011 in single academic oncology center. Demographic data, tumor characteristics, chemotherapy, surgical details, complications and survival were analyzed. Results: The study included 157 patients that underwent 168 liver operations. One hundred eighteen patients (70 {\%}) underwent preoperative chemotherapy (75 {\%} oxaliplatin-based). Preoperative portal vein embolization was utilized in 16 (10.1 {\%}) patients. Overall survival (OS) was 89, 57, and 27 {\%} at 1, 3, and 5 years, respectively (median survival-42.8 months). Eleven (7 {\%}) patients had repeat resections for liver recurrence. Thirty-day mortality was 1.26 {\%}, morbidity-24 {\%} (6 {\%}-liver related). Complications were not significantly different in patients that had preoperative chemotherapy. On a multivariate analysis advanced age and >3 lesions predicted poor OS, while advanced age, lesions >5 cm, synchronous lesions, margin-positivity and resection less than hepatectomy were associated with decreased DFS. Conclusions: Our results suggest that even with chemotherapy and resection only a subset of patients remain disease-free after 5 years. However, even in a high-risk patient with multiple lesions, preoperative chemotherapy can be administered safely without apparent increase in postoperative complications. Perioperative chemotherapy should be considered particularly in patients with multifocal or large lesions, synchronous disease and short disease-free interval.",
keywords = "Chemotherapy, Colorectal cancer, Colorectal liver metastases, FOLFOX, Liver resection, Outcomes, Portal vein embolization, Repeat resections",
author = "Ilia Gur and Diggs, {Brian S.} and Wagner, {Jesse A.} and Gina Vaccaro and Charles Lopez and Brett Sheppard and Susan Orloff and Kevin Billingsley",
year = "2013",
month = "12",
doi = "10.1007/s11605-013-2295-1",
language = "English (US)",
volume = "17",
pages = "2133--2142",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",
number = "12",

}

TY - JOUR

T1 - Safety and Outcomes Following Resection of Colorectal Liver Metastases in the Era of Current Perioperative Chemotherapy

AU - Gur, Ilia

AU - Diggs, Brian S.

AU - Wagner, Jesse A.

AU - Vaccaro, Gina

AU - Lopez, Charles

AU - Sheppard, Brett

AU - Orloff, Susan

AU - Billingsley, Kevin

PY - 2013/12

Y1 - 2013/12

N2 - Background: Preoperative chemotherapy is increasingly utilized in the treatment of colorectal liver metastases (CRLM). Although this strategy may improve resectability, long-term advantages of preoperative chemotherapy for resectable CRLM are less clear. The objective of this study is to report safety and outcomes when perioperative chemotherapy is routinely added to surgery for CRLM. Methods: A retrospective review of patients undergoing liver resections for CRLM during 2003-2011 in single academic oncology center. Demographic data, tumor characteristics, chemotherapy, surgical details, complications and survival were analyzed. Results: The study included 157 patients that underwent 168 liver operations. One hundred eighteen patients (70 %) underwent preoperative chemotherapy (75 % oxaliplatin-based). Preoperative portal vein embolization was utilized in 16 (10.1 %) patients. Overall survival (OS) was 89, 57, and 27 % at 1, 3, and 5 years, respectively (median survival-42.8 months). Eleven (7 %) patients had repeat resections for liver recurrence. Thirty-day mortality was 1.26 %, morbidity-24 % (6 %-liver related). Complications were not significantly different in patients that had preoperative chemotherapy. On a multivariate analysis advanced age and >3 lesions predicted poor OS, while advanced age, lesions >5 cm, synchronous lesions, margin-positivity and resection less than hepatectomy were associated with decreased DFS. Conclusions: Our results suggest that even with chemotherapy and resection only a subset of patients remain disease-free after 5 years. However, even in a high-risk patient with multiple lesions, preoperative chemotherapy can be administered safely without apparent increase in postoperative complications. Perioperative chemotherapy should be considered particularly in patients with multifocal or large lesions, synchronous disease and short disease-free interval.

AB - Background: Preoperative chemotherapy is increasingly utilized in the treatment of colorectal liver metastases (CRLM). Although this strategy may improve resectability, long-term advantages of preoperative chemotherapy for resectable CRLM are less clear. The objective of this study is to report safety and outcomes when perioperative chemotherapy is routinely added to surgery for CRLM. Methods: A retrospective review of patients undergoing liver resections for CRLM during 2003-2011 in single academic oncology center. Demographic data, tumor characteristics, chemotherapy, surgical details, complications and survival were analyzed. Results: The study included 157 patients that underwent 168 liver operations. One hundred eighteen patients (70 %) underwent preoperative chemotherapy (75 % oxaliplatin-based). Preoperative portal vein embolization was utilized in 16 (10.1 %) patients. Overall survival (OS) was 89, 57, and 27 % at 1, 3, and 5 years, respectively (median survival-42.8 months). Eleven (7 %) patients had repeat resections for liver recurrence. Thirty-day mortality was 1.26 %, morbidity-24 % (6 %-liver related). Complications were not significantly different in patients that had preoperative chemotherapy. On a multivariate analysis advanced age and >3 lesions predicted poor OS, while advanced age, lesions >5 cm, synchronous lesions, margin-positivity and resection less than hepatectomy were associated with decreased DFS. Conclusions: Our results suggest that even with chemotherapy and resection only a subset of patients remain disease-free after 5 years. However, even in a high-risk patient with multiple lesions, preoperative chemotherapy can be administered safely without apparent increase in postoperative complications. Perioperative chemotherapy should be considered particularly in patients with multifocal or large lesions, synchronous disease and short disease-free interval.

KW - Chemotherapy

KW - Colorectal cancer

KW - Colorectal liver metastases

KW - FOLFOX

KW - Liver resection

KW - Outcomes

KW - Portal vein embolization

KW - Repeat resections

UR - http://www.scopus.com/inward/record.url?scp=84888235220&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84888235220&partnerID=8YFLogxK

U2 - 10.1007/s11605-013-2295-1

DO - 10.1007/s11605-013-2295-1

M3 - Article

C2 - 24091909

AN - SCOPUS:84888235220

VL - 17

SP - 2133

EP - 2142

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

IS - 12

ER -