Type of response to conversion chemotherapy strongly impacts survival after hepatectomy for initially unresectable colorectal liver metastases

Type of response to conversion chemotherapy strongly impacts survival after hepatectomy for initially unresectable colorectal liver metastases:

Patients undergoing hepatectomy for initially unresectable colorectal liver metastases after conversion chemotherapy are at risk of (i) post‐operative complications related to prolonged preoperative chemotherapy and to more complex surgical procedures and (ii) short survival due to early disease recurrence. In this study, we compare short‐ and long‐term results of patients operated on at a high‐volume hepatobiliary centre for initially unresectable colorectal liver metastases versus initially resectable colorectal liver metastases.

Abstract

Background

Hepatectomy for initially unresectable colorectal liver metastases (IU‐CLM) is considered at high risk due to the extensive preoperative chemotherapy (CHT) and complex surgical procedures required, and its results are questioned due to frequent and early post‐operative recurrence. We aim to compare patients with initially resectable CLM (IR‐CLM) and IU‐CLM and identify prognostic factors among IU‐CLM patients.

Methods

A total of 81 patients with IU‐CLM, undergoing hepatectomy following conversion CHT, were compared to 526 IR‐CLM patients. Predictors of overall (OS) and disease‐free survival (DFS) were identified for IU‐CLM patients.

Results

Patients resected for IU‐CLM, compared to IR‐CLM, had more and larger CLM and more frequently underwent prolonged CHT and major/extended hepatectomy (P < 0.001 for all comparisons). Such characteristics paralleled higher rates of overall and major (Clavien‐Dindo ≥3) complications, longer median post‐operative length of stay and lower 5‐year survival rates (P < 0.001 for all comparisons) among IU‐CLM patients compared to IR‐CLM, with similar mortality (1.2% and nil for IU‐CLM and IR‐CLM, respectively). Among IU‐CLM patients, 62 with partial response to CHT (versus tumour stability according to the Response Evaluation Criteria in Solid Tumors criteria) had better DFS (hazard ratio 2.76, P = 0.001) and OS (hazard ratio 2.83, P =  0.002), and their 5‐year survival rates (DFS 19.8%, OS 46.7%) approached those of IR‐CLM patients (DFS 31%, OS 59%, P > 0.05 for both comparisons).

Conclusion

Resection of IU‐CLM has acceptable perioperative results. Tumour responsiveness to conversion CHT improves IU‐CLM patient selection for hepatectomy.