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10.1245/s10434-007-9533-2
Annals of Surgical Oncology 14:3519-3526 (2007)
© 2007 Society of Surgical Oncology
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Original Article

A Critical Appraisal of the Role of Neoadjuvant Chemotherapy for Colorectal Liver Metastases: A Case-Controlled Study

H. Z. Malik1, S. Farid1, A. Al-Mukthar1, A. Anthoney2, G. J. Toogood1, J. P. A. Lodge1 and K. R. Prasad3

1 Hepatobiliary and Transplantation Unit, The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
2 Oncology Unit, The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
3 Consultant Hepatobiliary and Transplant Surgeon, The Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF, USA

Correspondence: Address correspondence and reprint requests to: K. R. Prasad; E-mail: raj.prasad{at}leedsth.nhs.uk

Background: The aim of this study was to analyze the outcome of patients that received neoadjuvant chemotherapy prior to resection for colorectal liver metastases (CRLM) and compare them with a matched cohort of patients that underwent resection followed by adjuvant chemotherapy.

Methods: 687 patients have undergone curative resection between January 1993 and January 2006. In this period, 84 patients received neo-adjuvant chemotherapy and 71 of this group went on to resection. A control group was chosen, matched with these patients, made up of patients who underwent resection followed by adjuvant chemotherapy.

Results: There was no difference in clinico-pathological features between the neoadjuvant and the control group. However patients in the control group had more-extended resections and longer hospital stays than those in the neoadjuvant group (p = 0.015). Patients in the control group had an increased incidence of early recurrences (p < 0.001). Despite this, there was no significant difference in either the cancer-specific or the disease-free survival between the two groups of patients.

Conclusion: Neoadjuvant chemotherapy has a role in the management of patients with disease that is considered initially unresectable as a down-sizing technique. In patients with resectable disease, the test-of-time approach that neoadjuvant therapy offers is yet to be proven.

Key Words: Colorectal liver metastases • Neoadjuvant Chemotherapy • Liver resection • Oxaliplatin






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