title: Impact of preoperative targeted therapy on postoperative complications after resection of colorectal liver metastases.
abstract: OBJECTIVE
  The impact of chemotherapy (CTx) on morbidity after liver resection for colorectal metastases (CRC-LM) has been increasingly investigated during recent years. Biologic agents like bevacizumab (BEV) or cetuximab (CET) are now added as "targeted therapy" (TT), also in neoadjuvant settings. Initial series could demonstrate the safety of those regimens in liver resection but data are still scarce. We evaluated the impact of CTx with BEV or CET (CTx + TT) on perioperative morbidity and mortality.
  
  
  METHODS
  Two hundred thirty-seven patients who underwent liver resections for CRC-LM after chemotherapy before surgery since 1999 were included. One hundred eighty-five patients (78%) had preoperative CTx regimen without biologic agents (fluoropyrimidine-, oxaliplatin-, or irinotecan-based) and 52 (22%) had CTx + TT (39 BEV, 11 CET, 2 CET/BEV). After preoperative CTx + TT, a time interval of at least 4-6 weeks and a residual liver volume of >35% before surgery were required.
  
  
  RESULTS
  Hemihepatectomy or more was performed in about half of the patients. The median amount of intraoperatively transfused blood was 0 ml in both groups (p = 0.34). Overall mortality was 1.7% and slightly elevated in patients with CTx + TT (3.8% vs. 1.1%, p = 0.17). Any complication occurred in (CTx + TT vs. CTx) 52% and 46%, respectively (p = 0.47). The rates of liver failure (9.6% vs. 9.7%, p = 0.98), infectious complications such as wound infection (19% vs. 16%, p = 0.62) and abdominal abscess (8% vs. 6.5%, p = 0.71), as well as the rate of relaparotomies (11.5% vs. 7.0%, p = 0.29) showed no significant differences between the groups with TT or without. In multivariate analyses, neither type nor duration of CTx nor the time interval between CTx and surgery showed any influence on complication rates.
  
  
  CONCLUSIONS
  Our data confirm the safety of targeted therapy before liver resection for CRC-LM. This effect may in part be due to our treatment policy (time interval to resection and residual liver volume) after intensive preoperative CTx.
authors.affiliation: Department of Surgery, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. hannes.neeff@uniklinik-freiburg.de
authors.forename: Hannes P
authors.initials: HP
authors.lastname: Neeff
authors.forename: Oliver
authors.initials: O
authors.lastname: Drognitz
authors.forename: Andrea
authors.initials: A
authors.lastname: Klock
authors.forename: Gerald
authors.initials: G
authors.lastname: Illerhaus
authors.forename: Oliver G
authors.initials: OG
authors.lastname: Opitz
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
authors.forename: Frank
authors.initials: F
authors.lastname: Makowiec
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab; D000068818:Cetuximab; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016503:Drug Delivery Systems; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis / Q000188:drug therapy; D011183:Postoperative Complications / Q000188:drug therapy*; D057234:Preoperative Period; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D000068818:Cetuximab