Minimally Invasive Resection of Colorectal Cancer Liver Metastases Leads to an Earlier Initiation of Chemotherapy Compared to Open Surgery

Abstract

Introduction: Previous studies have shown benefit not only from postoperative chemotherapy but also from a short interval to initiation of treatment after resection of primary colorectal cancer. The aim of this study was to determine difference in timing to postoperative chemotherapy for minimally invasive resection (MIR) vs. open resection (OR) of colorectal cancer liver metastases (CRCLM).

Methods: This is a retrospective review of 1:1 matched patients undergoing MIR (n = 66) and OR (n = 66) for CRCLM at a single institution.

Results: Patients undergoing MIR of CRCLM had significantly shorter length of hospital stay, fewer major complications, and shorter interval to postoperative chemotherapy (median 42 vs. 63 days, p < 0.001). Univariable analysis showed that surgical approach, postoperative complications, blood loss, number of lesions, and length of stay were associated with timing to chemotherapy. On multivariable analysis, surgical approach was still associated with timing to chemotherapy, and postoperative complications resulted in a delay of chemotherapy among patients who underwent OR but not among those who underwent MIR. In addition, worse disease-free survival was seen among patients who received postoperative chemotherapy more than 60 days after surgery.

Conclusion: By modifying the deleterious effects of postoperative complications on timing of postoperative chemotherapy, patients undergoing MIR for CRCLM are treated with chemotherapy sooner after surgery compared to those undergoing OR.

Keywords: Hepatic resection; Laparoscopic liver resection; Metastatic colorectal cancer; Minimally invasive surgery; Postoperative chemotherapy.

Conflict of interest statement

Conflict of Interest The authors declare that they have no competing interests.

Figures

Fig. 1

a Probability of starting chemotherapy for minimally invasive vs. open resection. b Probability of starting postoperative chemotherapy as a function of postoperative complication. c Probability of starting postoperative chemotherapy for minimally invasive vs. open resection +/− postoperative complications

Fig. 2

Kaplan-Meier curve of recurrence-free survival as a function of postoperative chemotherapy within 60 days