E278: Impact of neoadjuvant chemotherapy on post-hepatectomy outcomes for colorectal liver metastasis

Neoadjuvant chemotherapy is an important treatment strategy for patients with colorectal liver metastasis. However, the role remains controversial given the potential risk of inducing chemotherapy-associated liver injury prior to hepatectomy. We aimed to evaluate short term outcomes in patients who underwent liver resection for colorectal liver metastasis with or without neoadjuvant chemotherapy.

Methods: We performed three-year (2019-2021) analysis of American College of Surgeons-National Surgical Quality Improvement Program Database. We included all adult patients who were diagnosed with colorectal liver metastases and underwent liver resection. We stratified patients into two groups based on if they received neoadjuvant systemic chemotherapy or not. We examined baseline clinicopathologic and disease-related characteristics and compared outcomes. Our outcome measures were final liver texture, rates of liver failure, bile leak and inpatient mortality, and hospital length of stay.

Results: We included 4799 patients who underwent partial liver resection. Mean age was 59.7 ± 11 years and 59.2% were males. 60% of the patients received neoadjuvant chemotherapy. 75% of patients underwent partial liver lobectomy while 12.7% underwent right lobectomy and 5.7% underwent left lobectomy. 62% of patients underwent planned open resection and only 1.5% of the patients had biliary reconstruction. Patient who received neoadjuvant chemotherapy were more likely to undergo open resection (65% vs 56%, p< 0.001). Table 1. Demonstrates outcome measures. Patient who underwent liver resection after neoadjuvant chemotherapy were more likely to have fatty and fibrotic liver (p< 0.001) and had higher rates of liver failure (p=0.03) with similar mortality rates (0.44). On regression analysis, after controlling for age, gender, number to liver resection, type of surgery, and anesthesia, neoadjuvant chemotherapy was associated with higher rates of post op liver failure (OR: 1.69 [1.2-2.3] p=0.002).

Conclusions:

In patients with colorectal liver metastasis, neoadjuvant chemotherapy was associated with liver toxicity and higher rates of post hepatectomy liver failure. Patients with colorectal liver metastasis who received neoadjuvant chemotherapy should be thoroughly evaluated prior to liver resection.