title: Preoperative chemotherapy and the outcome of liver resection for colorectal metastases.
abstract: BACKGROUND
  Neoadjuvant systemic chemotherapy is being increasingly used prior to liver resection for colorectal metastases. Oxaliplatin has been implicated in causing structural changes to the liver parenchyma, and such changes may increase the morbidity and mortality of surgery.
  
  
  METHODS
  A retrospective study was undertaken of 101 consecutive patients who had undergone liver resection for colorectal metastases in two HPB centers. Preoperative demographic and premorbid data were gathered along with liver function tests and tumor markers. A subjective assessment of the surgical procedure was noted, and in-hospital morbidity and mortality were calculated. The effect of preoperative chemotherapy on short-term and long-term outcome was analyzed, and actuarial 1 and 3 year survival was determined.
  
  
  RESULTS
  Patients who received neoadjuvant chemotherapy had a higher number of metastases (median 2, range 1-8 versus median 1, range 1-5; P = 0.019) and more had synchronous tumors (24 patients versus 8; P < 0.001). Overall morbidity was 37% and hospital mortality was 3.9%. Operative and in-hospital outcome was not influenced by chemotherapy. Long-term survival was worse in patients who had received preoperative chemotherapy (actuarial 3-year survival 62% versus 80%; P = 0.04).
  
  
  CONCLUSIONS
  This study shows no evidence that neoadjuvant chemotherapy, and in particular oxaliplatin, increases the risk associated with liver resection for colorectal metastases. Long-term outcome is reduced in patients receiving preoperative chemotherapy, although they have more advanced disease.
authors.affiliation: University Department of Surgery, Academic Division of Surgical Specialties, The Royal Free Hospital and Royal Free campus, Royal Free and University College School of Medicine, UCL, London, United Kingdom, NW3 2QG.
authors.forename: J C
authors.initials: JC
authors.lastname: Hewes
authors.forename: S
authors.initials: S
authors.lastname: Dighe
authors.forename: R W
authors.initials: RW
authors.lastname: Morris
authors.forename: R R
authors.initials: RR
authors.lastname: Hutchins
authors.forename: S
authors.initials: S
authors.lastname: Bhattacharya
authors.forename: B R
authors.initials: BR
authors.lastname: Davidson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology*; D004334:Drug Administration Schedule; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents