title: Minimally Invasive Resection of Colorectal Cancer Liver Metastases Leads to an Earlier Initiation of Chemotherapy Compared to Open Surgery.
abstract: BACKGROUND
  Previous studies have shown benefit not only from postoperative chemotherapy but also from a short interval to initiation of treatment after resection of primary colorectal cancer. The aim of this study was to determine difference in timing to postoperative chemotherapy for minimally invasive resection (MIR) vs. open resection (OR) of colorectal cancer liver metastases (CRCLM).
  
  
  METHODS
  This is a retrospective review of 1:1 matched patients undergoing MIR (n = 66) and OR (n = 66) for CRCLM at a single institution.
  
  
  RESULTS
  Patients undergoing MIR of CRCLM had significantly shorter length of hospital stay, fewer major complications, and shorter interval to postoperative chemotherapy (median 42 vs. 63 days, p < 0.001). Univariable analysis showed that surgical approach, postoperative complications, blood loss, number of lesions, and length of stay were associated with timing to chemotherapy. On multivariable analysis, surgical approach was still associated with timing to chemotherapy, and postoperative complications resulted in a delay of chemotherapy among patients who underwent OR but not among those who underwent MIR. In addition, worse disease-free survival was seen among patients who received postoperative chemotherapy more than 60 days after surgery.
  
  
  CONCLUSIONS
  By modifying the deleterious effects of postoperative complications on timing of postoperative chemotherapy, patients undergoing MIR for CRCLM are treated with chemotherapy sooner after surgery compared to those undergoing OR.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA, 15213, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: Tohme
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA, 15213, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Goswami
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA, 15213, USA.
authors.forename: Katrina
authors.initials: K
authors.lastname: Han
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA, 15213, USA.
authors.forename: Alexis P
authors.initials: AP
authors.lastname: Chidi
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA, 15213, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
authors.affiliation: Hepatobiliary and Pancreatic Surgery, Virginia Piper Cancer Institute-Allina Health, 800 East 28th Street, Ste 602, Minneapolis, MN, 55415, USA.
authors.forename: Srinevas
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA, 15213, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Gleisner
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA, 15213, USA. tsunga@upmc.edu.
authors.forename: Allan
authors.initials: A
authors.lastname: Tsung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Hepatic resection; Laparoscopic liver resection; Metastatic colorectal cancer; Minimally invasive surgery; Postoperative chemotherapy