CRC liver metastasis: NACT shows no effect on postoperative morbidity

  • Wiseman JT & al.
  • J Am Coll Surg
  • 21 Mar 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Neoadjuvant chemotherapy (NACT) was not associated with more complications, biliary fistula, posthepatectomy liver failure, or increased mortality in patients undergoing resection for colorectal cancer (CRC) liver metastases.

Why this matters

  • NACT is known to have hepatotoxic effects, but previous studies showed mixed results as to whether postoperative morbidity/mortality is affected. The authors used propensity score matching to address the question.

Study design

  • Retrospective, propensity-score matched analysis of 2832 patients (50% receiving NACT) from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Targeted Hepatectomy database.
  • Funding: None disclosed.

Key results

  • The NACT and non-NACT groups had similar rates (P>.05) of overall 30-day morbidity (34% vs 33%), mortality (0.8% vs 0.7%), bile leak (6% vs 5%), posthepatectomy liver failure (5% vs 5%), and posthepatectomy intervention (8% vs 8%).
  • In a multivariate analysis, NACT was not associated with increased risk for postoperative complications (OR, 1.07; P=.43) or postoperative mortality (OR, 1.09; P=.85).
  • There was no difference in morbidity or mortality associated with NACT in patients undergoing a right hepatectomy or trisegmentectomy (n=649).

Limitations

  • Retrospective analysis.

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