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Impact of Targeted Therapy On Complications After Resection of Colorectal Liver Metastases
Frank Makowiec*1,2, Oliver Drognitz1, Hannes P. Neeff1, Tobias Keck1,2, Oliver G. Opitz2, Ulrich T. Hopt1,2
1Dept. of Surgery, University of Freiburg, Freiburg, Germany; 2Comprehensive Cancer Center, University of Freiburg, Freiburg, Germany
The impact of chemotherapy (oxaliplatin, irinotecan) on liver parenchyma and morbidity after liver resection for colorectal metastases (CRC-LM) has been increasingly investigated during the recent years. Antibodies (AB) like bevacizumab (BEV) or cetuximab (CET) are now frequently added in neoadjuvant (for CRC-LM) settings. Some initial series could show a safety of those antibodies regarding liver resection but data are still rare. In this study we evaluated the impact of chemotherapies (CTx) with BEV or CET on perioperative morbidity after liver resection. Methods: Since 1999 246 liver resections were performed for CRC-LM in patients who had had any form of chemotherapy before surgery (prospective database). 200 patients (81%) had various preoperative CTx-regimen without AB (most fluorouracil-, oxaliplatin- or irinotecan-based; including adjuvant after CRC) and 46 (19%) had CTX with AB (34 BEV, 9 CET, 3 CET/BEV). Liver failure was defined as postoperative bilirubin > 6 mg%, biliary complication as bile leak or symptomatic bilioma, mortality as in-hospital death. After intensive preoperative CTx a time interval of at least 4 weeks before surgery and a residual liver volume of at least 35% (compared to 25% in patients without CTx) was required. The CTx-groups with and without ABs were compared regarding perioperative outcomes. Results: A hemihepatectomy was performed in 50% (no difference between both groups). The median volume of intraoperatively transfused blood was 0 ml in both groups (p=0.53). Overall mortality was 1.6% and non-significantly elevated in patients with CTx/AB (4.3% vs. 1% in CTX/noAB; p=0.11). Any complication occurred in (AB vs. no AB) 56% and 46%, respectively (p=0.20). The rates of liver failure (11% vs 9%), biliary complications (23% vs 15%), infectious complications (30% vs 20%) and relaparotomies (13% vs 8%) also showed no significant differences.Conclusions: Our data confirm the relative safety of antibodies in CTx before liver resection for CRC-LM. This effect may in part be due to our treatment policy (time interval and residual liver volume) after intensive preoperative CTx.
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