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01.05.2009 | Ausgabe 5/2009

World Journal of Surgery 5/2009

Is There a Survival Benefit to Neoadjuvant Versus Adjuvant Chemotherapy, Combined with Surgery for Resectable Colorectal Liver Metastases?

Zeitschrift:
World Journal of Surgery > Ausgabe 5/2009
Autoren:
Nir Lubezky, Ravit Geva, Einat Shmueli, Richard Nakache, Joseph M. Klausner, Arie Figer, Menahem Ben-Haim
Wichtige Hinweise
Portions of this article were presented before the American Pancreato-Biliary Association (AHPBA) annual meeting (2006, Miami Beach) and the International Pancreato-Biliary Association (IHPBA) meeting (2006, Edinburgh).

Abstract

Background

The benefits of adding chemotherapy to surgery in patients with hepatic colorectal metastases at moderate and high risk for recurrence and the optimal sequence of administration are undetermined.

Methods

We followed the overall-survival and event-free survival rates after operation in patients with resectable colorectal metastases confined to the liver. The adjuvant patients first underwent surgery and then treatment, whereas the neoadjuvant patients underwent treatment, surgery, and re-treatment. Assignment was by oncologist and patient preferences. Chemotherapy was oxaliplatin (FOLFOX) or irinotecan (FOLFIRI) based.

Results

Fifty-six of 105 patients who underwent liver resections for colorectal metastases (2002–2005) are included. The two groups were comparable for demographics, characteristics of disease (including recurrence risk), treatment protocols, and follow-up. The respective 1-, 2-, and 3-year overall survival rates were 91%, 91%, and 84%, and the event-free survival rates were 63%, 49%, and 49% for the 19 adjuvant patients, and 95%, 91%, and 70%, and 94%, 50%, and 50% for the 37 neoadjuvant patients.

Conclusions

The midterm overall survival and disease-free survival rates in this group of patients with resectable colorectal metastases to the liver, who were treated with combination of resection and chemotherapy, were similar, regardless of the sequence of treatment.

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