Effect of chemotherapy and tumor clearance in hepatic resections for colorectal liver metastases. A single-centre cohort study.

Abstract

BackgroundColorectal cancer (CRC) is the third most prevalent cancer and accounts for the second leading cause of cancer-related deaths. Up to 50% of CRC patients develop synchronous (10–20%) or metachronous liver deposits (20–30%). Hepatic resection is the gold standard and only curative treatment for colorectal liver metastases (CRLM). While excision significantly improves survival outcomes, more than 50% of patients experience recurrence after primary hepatic resection and usually, within the first 24 months after surgery. ObjectiveTo determine rates and patterns of recurrence following liver resections for CRLM at The Queen Elizabeth Hospital (Adelaide, Australia), and concurrently, characterise clinical, pathological, and treatment-related factors that could function as predictors of recurrence or survival, particularly neoadjuvant chemotherapy, and tumour clearance. MethodsRetrospective analysis of a prospectively collected database of 170 patients between 2004 and 2020, who underwent liver resections for CRLM at The Queen Elizabeth Hospital. ResultsThe prevalence of recurrence following liver resection for CRLM was 53.5% (84/157), with recurrence most likely to occur during the first 12 months post-surgery (median 209 days). Neoadjuvant chemotherapy was associated with a higher recurrence (X2 = 10.587, p-value = 0.001) rate in the univariate and multivariate analysis while resection margins greater than 1 mm showed to decrease the recurrence rate (X2 3.898, p = 0.047). Recurrence was significantly associated with a decreased overall survival (HR 2.58 [1.73; 3.85], p < 0.001), while neoadjuvant chemotherapy showed a negative non-significant marginal effect. ConclusionDespite the development of innovative diagnostic and therapeutic techniques for CRC and CRLM, the recurrence incidence remains high, and survival low. The role and impact of neoadjuvant chemotherapy and resection margins should continue to be reviewed to improve therapeutic outcomes for CRLM.