Neoadjuvant chemotherapy does not increase risk for anastomotic leak for simultaneous resection of primary colon cancer with synchronous liver metastasis: A NSQIP‐colectomy analysis

Abstract

Background and Objectives In patients with colon cancer with synchronous liver metastasis, treatment algorithms are complex and often require multidisciplinary evaluation. Neoadjuvant therapy is frequently utilized, but there is an unclear relationship with postoperative outcomes in patients with simultaneous resection. Methods This is a retrospective cohort study from the National Surgical Quality Improvement Program and Targeted Colectomy databases. All patients with stage IV colon cancer undergoing simultaneous colectomy with synchronous liver metastasis resection or ablation between 2015 and 2019 were identified and categorized into subgroups based on receipt of neoadjuvant chemotherapy. Multivariable logistic regression was utilized to assess for risk factors of anastomotic leaks and serious postoperative complications. Results We identified 1006 patients who underwent simultaneous colectomy and liver operations. Of those, 418 (41.6%) received neoadjuvant chemotherapy within 90 days of surgery, while 588 (58.4%) had simultaneous upfront surgery. On multivariable logistic regression, neoadjuvant therapy was not associated with postoperative anastomotic leaks (odds ratio [OR]: 1.30; p = 0.39) or serious complications (OR: 1.04; p = 0.82). Conclusion Neoadjuvant therapy does not increase postoperative complications in simultaneous colon and liver resections. These results may alleviate concerns regarding postoperative morbidity in the decision‐making process of administering neoadjuvant therapy.

Prevention of Anastomotic Leak in Colorectal Surgery: Current Knowledge and Next Steps

“…Patients with synchronous liver metastases (which accounted for 80% of patients with Stage IV colon cancer) were compared between those who had surgery upfront versus those who had neoadjuvant chemotherapy followed by surgery, and they found no difference in anastomotic leak in both univariate and multivariate analysis. 48 Cheong et al, in their meta-analysis of five RCTs and two observational studies examining the effects of neoadjuvant therapy for locally advanced colon cancer also concurred that there was no associated increase anastomotic leak rates (relative risk of 0.83, p = 0.42). 49 https://doi.org/10.2147/OAS.S429415…”