This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. BJS 2006; 93: 1001-1006.
Published: 31st May 2006
Authors: L. Capussotti, A. Muratore, M. M. Mulas, P. Massucco, M. Aglietta
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.
Method
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 per cent (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. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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