Safety of hepatic resection for colorectal metastases in the era of neo-adjuvant chemotherapy

Cucchetti, Alessandro; Ercolani, Giorgio; Cescon, Matteo; Gioia, P. Di; Peri, Eugenia; Brandi, Giovanni; Pellegrini, Sara; Pinna, Antonio Daniele

doi:10.1007/s00423-011-0894-4

Cited by 10 publications

(8 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nine studies presented data on complications related to hepatic resection in NEO and SG [12, 13, 17, 19, 21, 22, 25, 26, 28]. The pooled overall OR for NEO was 0.94 (95% CI: 0.89-0.96; p = 0.03; I 2 = 62.3%, p = 0.01), indicating that neoadjuvant chemotherapy increased the incidence of post-operative complication rate after hepatic resection, as compared to SG (Supplementary Figure 4).…”

Section: Resultsmentioning

confidence: 99%

The role of neoadjuvant chemotherapy for resectable colorectal liver metastases: a systematic review and meta-analysis

et al. 2016

View full text Add to dashboard Cite

Neoadjuvant chemotherapy is being increasingly accepted as an effective treatment of resectable colorectal liver metastases (CRLM), but it may also damage the hepatic parenchyma. We performed a meta-analysis to compare the outcomes of patients who received neoadjuvant chemotherapy (NEO) prior to hepatic resection with hepatic resection without neoadjuvant chemotherapy (SG). Eligible trials were identified from Embase, PubMed, the Web of Science and the Cochrane library. Hazard ratios (HRs) with a 95% confidence intervals (CIs) were used to measure the pooled effect using a random-effects model. Statistical heterogeneity was detected by I2 test. Sensitivity analyses and publication bias were also assessed. The study outcomes included 3-year, 5-year disease-free and overall survival rate, respectively. Eighteen studies involving 6,254 patients were included. The pooled HRs for 5-year DFS and 5-year OS for NEO in the included studies calculated using the random-effects model were 1.38 (95 % CI; 1.26-1.51, p=0.00; I2=9.6%, p=0.36) and 1.19 (95% CI: 1.02-1.38; p=0.03; I2=49.2%, p=0.03), respectively. For CRLM patients with factors indicating a high risk of recurrence, the pooled HR for 5-year OS of NEO in the included studies calculated using the random-effects model was 0.69 (95% CI: 0.55-0.87; p=0.00; I2=0.0%, p=0.48). These results suggest neoadjuvant chemotherapy improved survival of patients with initially resectable CRLM and a high risk of disease recurrence.

show abstract

Section: Resultsmentioning

confidence: 99%

The role of neoadjuvant chemotherapy for resectable colorectal liver metastases: a systematic review and meta-analysis

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Six studies[ 40 , 42 , 45 , 53 , 56 , 57 ] reported the length of hospital stay (Figure 7 ), 13 studies[ 6 , 7 , 9 , 35 , 39 , 42 - 45 , 49 , 55 - 57 ] reported the size of the largest metastasis (Figure 8 ), and six studies[ 1 , 7 , 35 , 42 , 43 , 57 ] reported blood loss during surgery (Figure 9 ). The results of the meta–analysis showed no significant statistical difference between these three indicators in the two groups (SMD = 0.20, 95%CI: -0.61-1.02, P = 0.624, I² = 97.3%; SMD = -0.00, 95%CI: -0.31-0.30, P = 0.980, I² = 92.9%; SMD = 0.53, 95%CI: -0.05-1.10 P = 0.072, I² = 94.5%).…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies[ 1 , 9 , 34 - 36 , 40 , 42 - 44 , 46 , 50 , 53 , 56 , 59 ] reported major liver resection (Figure 11 ), seven studies[ 1 , 7 , 9 , 42 , 44 , 50 , 52 ] reported R0 liver resections (Figure 12 ), and five studies[ 7 , 34 , 35 , 45 , 53 ] reported blood transfusions (Figure 13 ). The results of the meta-analysis showed no significant statistical difference between the three indicators in the two groups (OR = 1.09, 95%CI: 0.97-1.22, P = 0.143, I 2 = 0.0%; OR = 0.85, 95%CI: 0.61-1.18, P = 0.336, I 2 = 4.6%; OR = 1.07, 95%CI: 0.90-1.29, P = 0.438).…”

Section: Resultsmentioning

confidence: 99%

Neoadjuvant chemotherapy for patients with resectable colorectal cancer liver metastases: A systematic review and meta-analysis

Zhang¹,

Ge²,

Weng³

et al. 2021

WJCC

View full text Add to dashboard Cite

BACKGROUND In recent years, neoadjuvant chemotherapy (NAC) has been increasingly used in patients with resectable colorectal liver metastases. However, the efficacy and safety of NAC in the treatment of resectable colorectal liver metastases (CRLM) are still controversial. AIM To assess the efficacy and application value of NAC in patients with resectable CRLM. METHODS We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to December 2020 to collect clinical studies comparing NAC with non-NAC. Data processing and statistical analyses were performed using Stata V.15.0 and Review Manager 5.0 software. RESULTS In total, 32 studies involving 11236 patients were included in this analysis. We divided the patients into two groups, the NAC group (that received neoadjuvant chemotherapy) and the non-NAC group (that received no neoadjuvant chemotherapy). The meta-analysis outcome showed a statistically significant difference in the 5-year overall survival and 5-year disease-free survival between the two groups. The hazard ratio (HR) and 95% confidence interval (CI) were HR = 0.49, 95%CI: 0.39-0.61, P = 0.000 and HR = 0.48 95%CI: 0.36-0.63, P = 0.000. The duration of surgery in the NAC group was longer than that of the non-NAC group [standardized mean difference (SMD) = 0.41, 95%CI: 0.01-0.82, P = 0.044)]. The meta-analysis showed that the number of liver metastases in the NAC group was significantly higher than that in the non-NAC group (SMD = 0.73, 95%CI: 0.02-1.43, P = 0.043). The lymph node metastasis in the NAC group was significantly higher than that in the non-NAC group (SMD = 1.24, 95%CI: 1.07-1.43, P = 0.004). CONCLUSION We found that NAC could improve the long-term prognosis of patients with resectable CRLM. At the same time, the NAC group did not increase the risk of any adverse event compared to the non-NAC group.

show abstract

“…In the present study, the use of neoadjuvant chemotherapy did not have a significant impact on surgical safety, as reported by others. 16,17 Even the patients who underwent preoperative bevacizumab, which has been web color only reported as a potential risk factor for increased postoperative morbidity, 18,19 showed a similar rate of postoperative complications to that of the general population.…”

Section: Discussionmentioning

confidence: 97%

Preoperative Chemotherapy and Resection Margin Status in Colorectal Liver Metastasis Patients: A Propensity Score–Matched Analysis

Solaini

Gardini

Passardi

et al. 2019

The American Surgeon™

Self Cite

View full text Add to dashboard Cite

In this article, we compared the early and long-term outcomes of patients with metastatic colorectal cancer treated with chemotherapy followed by resection with those of patients undergoing surgery first, focusing our analysis on resection margin status. Patients who underwent liver resection with curative intent for colorectal liver metastases from July 2001 to January 2018 were included in the analysis. Propensity score matching was used to reduce treatment allocation bias. The cohort comprised 164 patients; 117 (71.3%) underwent liver resection first, whereas the remaining 47 (28.7%) had preoperative chemotherapy. After a 1:1 ratio of propensity score matching, 47 patients per group were evaluated. A positive resection margin was found in 13 patients in the surgery-first group (25.5%) versus 4 (8.5%) in the preoperative chemotherapy group ( P = 0.029). Postmatched logistic regression analysis showed that only preoperative chemotherapy was significantly associated with the rate of positive resection margin (odds ratio 0.24, 95% confidence interval 0.07–0.81; P = 0.022). Median follow-up was 41 months (interquartile range 8–69). Cox proportional hazard regression analysis revealed that only positive resection margin was a significant negative prognostic factor (hazard ratio 2.2, 95% CI 1.18–4.11; P = 0.014). Within the preoperative chemotherapy group, median overall survival was 40 months in R0 patients and 10 months in R1 patients ( P = 0.016). Although preoperative chemotherapy in colorectal liver metastasis patients may affect the rate of positive resection margin, its impact on survival seems to be limited. In the present study, the most important prognostic factor was the resection margin status.

show abstract

Safety of hepatic resection for colorectal metastases in the era of neo-adjuvant chemotherapy

Abstract: Neo-adjuvant chemotherapy showed a limited role in determining post-operative morbidity after hepatic resection and did not modify mortality.

Cited by 10 publications

References 33 publications

The role of neoadjuvant chemotherapy for resectable colorectal liver metastases: a systematic review and meta-analysis

The role of neoadjuvant chemotherapy for resectable colorectal liver metastases: a systematic review and meta-analysis

Neoadjuvant chemotherapy for patients with resectable colorectal cancer liver metastases: A systematic review and meta-analysis

Preoperative Chemotherapy and Resection Margin Status in Colorectal Liver Metastasis Patients: A Propensity Score–Matched Analysis

Contact Info

Product

Resources

About