title: Peri-operative chemotherapy for resectable colorectal liver metastasis: does timing of systemic therapy matter?
abstract: BACKGROUND
  The benefit of pre-operative chemotherapy in patients with resectable colorectal liver metastases (CRLM) remains ill defined. We sought to evaluate the impact of peri-operative systemic chemotherapy timing on outcome following resection of CRLM.
  
  
  METHODS
  676 patients who underwent surgery for CRLM were identified from two hepatobiliary center databases. Data were collected and analyzed utilizing multivariate, matched, and propensity-score analyses.
  
  
  RESULTS
  Median number of metastases was 2 and median tumor size was 3.3 cm. 334 patients (49.4%) received pre-operative chemotherapy while 342(50.6%) did not. Surgical treatment was resection only (n = 555; 82.1%; minor hepatectomy, n = 399; 59.1%). While there was no difference in morbidity following minor liver resection (pre-operative chemotherapy: 17.9% versus no pre-operative chemotherapy: 16.5%; P = 0.72), morbidity was higher after major hepatic resection (pre-operative chemotherapy: 23.1% versus no pre-operative chemotherapy: 14.2%; P = 0.06). Patients treated with pre-operative chemotherapy had worse 5-year survival (43%) as compared to patients not treated with pre-operative chemotherapy (55%)(P = 0.009). Controlling for baseline characteristics, pre-operative chemotherapy was not associated with outcome on multivariate (HR = 1.04, P = 0.87) or propensity-score analysis (HR = 1.40, P = 0.12).
  
  
  CONCLUSIONS
  Pre-operative chemotherapy was associated with a trend toward increased morbidity among patients undergoing a major hepatic resection. Receipt of pre-operative chemotherapy was associated with neither an advantage nor disadvantage in terms of long-term survival.
authors: Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital, Lisbon, Portugal.
authors: Hugo
authors: H
authors: Pinto Marques
authors: Eduardo
authors: E
authors: Barroso
authors: Mechteld C
authors: MC
authors: de Jong
authors: Michael A
authors: MA
authors: Choti
authors: Vasco
authors: V
authors: Ribeiro
authors: Ana Marta
authors: AM
authors: Nobre
authors: Carlos
authors: C
authors: Carvalho
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D000077146:Irinotecan; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D011183:Postoperative Complications; D057216:Propensity Score; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002166:Camptothecin