Abstract
In this article, we compared the early and long-term outcomes of patients with metastatic colorectal cancer treated with chemotherapy followed by resection with those of patients undergoing surgery first, focusing our analysis on resection margin status. Patients who underwent liver resection with curative intent for colorectal liver metastases from July 2001 to January 2018 were included in the analysis. Propensity score matching was used to reduce treatment allocation bias. The cohort comprised 164 patients; 117 (71.3%) underwent liver resection first, whereas the remaining 47 (28.7%) had preoperative chemotherapy. After a 1:1 ratio of propensity score matching, 47 patients per group were evaluated. A positive resection margin was found in 13 patients in the surgery-first group (25.5%) versus 4 (8.5%) in the preoperative chemotherapy group (P = 0.029). Postmatched logistic regression analysis showed that only preoperative chemotherapy was significantly associated with the rate of positive resection margin (odds ratio 0.24, 95% confidence interval 0.07-0.81; P = 0.022). Median follow-up was 41 months (interquartile range 8-69). Cox proportional hazard regression analysis revealed that only positive resection margin was a significant negative prognostic factor (hazard ratio 2.2, 95% CI 1.18-4.11; P = 0.014). Within the preoperative chemotherapy group, median overall survival was 40 months in R0 patients and 10 months in R1 patients (P = 0.016). Although preoperative chemotherapy in colorectal liver metastasis patients may affect the rate of positive resection margin, its impact on survival seems to be limited. In the present study, the most important prognostic factor was the resection margin status.
Highlights
In this article, we compared the early and long-term outcomes of patients with metastatic colorectal cancer treated with chemotherapy followed by resection with those of patients undergoing surgery first, focusing our analysis on resection margin status
The analysis focused on the potential effect of preoperative chemotherapy on resection margin status and on the impact of the latter on survival, exploiting propensity score matching
Variables included in propensity score matching were age, gender, American Society of Anaesthesiologists physical status (ASA) score, number of lesions (>2 vs #2), and type of primary and synchronous liver metastasis
Summary
This retrospective cohort study was designed and carried out in accordance with Strengthening the Reporting of Cohort Studies in Surgery criteria.[8] All patients who had undergone liver resection with curative intent for CLMs at our center from July 1, 2001, THE AMERICAN SURGEON May 2019. The entire cohort was divided into two groups (preoperative chemotherapy and surgery first). The primary outcome measure was the rate of positive resection margin. Secondary outcomes included overall survival (OS) and disease-free survival (DFS). Indications for preoperative chemotherapy/surgery first were confirmed by a multidisciplinary team comprising gastroenterologists, radiologists, oncologists, and surgeons. Major hepatectomy was defined as the resection of $4 liver segments.[9] OS was defined as the TABLE 1. DFS was defined as the period from liver resection to the date of the first documented evidence recurrence by imaging. Postoperative complications were classified according to Dindo et al.[10]
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