Journal Article

Impact of preoperative chemotherapy on perioperative morbidity in combined resection of colon cancer and liver metastases

Stem, Miloslawa, Radomski, Shannon N., Atallah, Chady, Papanikolaou, Angelos, Chen, Sophia Y., Done, Joy Z., Efron, Jonathan E., Safar, Bashar

2023

Overview

Background Preoperative chemotherapy, or neoadjuvant therapy (NAC) can be used to improve resectability but can also have hepatotoxic effects on the future liver remnant. The purpose of this study was to investigate the impact of NAC on 30-day morbidity among patients undergoing a resection of primary colon cancer and synchronous liver metastases (sLM). Methods This was a retrospective study using the National Surgical Quality Improvement Program database (2012–2020). The association between NAC and 30-day overall morbidity, the primary outcome, was assessed. Subgroup analyses for low and high-risk procedures were performed. Results Among 968 patients who underwent the combined resection, 571 (58.99%) received NAC. There was a lower rate of 30-day overall morbidity among patients who received NAC (34.50% vs. 41.56%, p  = 0.026) and no difference in rates of postoperative liver failure, bile leak, need for invasive intervention for hepatic procedure, and anastomotic leak. On adjusted analyses, patients who received NAC had decreased odds of overall morbidity (OR 0.73, 95% CI 0.55–0.97, p  = 0.031) compared to patients who did not receive NAC. On subgroup analyses, patients who received NAC prior to a low risk combined resection had lower rates of overall morbidity on both adjusted and unadjusted analyses. Among those undergoing high-risk combined resections, there was no difference in overall morbidity. Discussion and Conclusion Patients who are deemed to be candidates for preoperative chemotherapy can proceed with planned neoadjuvant chemotherapy prior to combined resection of primary colon cancer and sLM as preoperative neoadjuvant chemotherapy does not appear to be associated with increased postoperative morbidity.

• Publisher: Springer US,Springer Nature B.V
• Subject: Chemotherapy / Colonic Neoplasms - drug therapy / Colonic Neoplasms - surgery / Colorectal cancer / Colorectal Neoplasms - pathology / Gastroenterology / Hepatectomy - methods / Humans / Liver / Liver failure / Liver Neoplasms - drug therapy / Liver Neoplasms - surgery / Medicine / Medicine & Public Health / Metastasis / Morbidity / Neoadjuvant Therapy / Original Article / Retrospective Studies / Surgery / Surgical anastomosis