What is the optimal timing of surgery for liver metastasis after chemotherapy in patients with colorectal cancer?

The study evaluated the optimal timing of surgery for colorectal cancer liver metastasis (CRLM) after chemotherapy (CT). The main finding was that surgery within 5 weeks after CT may improve patients' outcomes.

Chemotherapy (CT) is used before surgery to remove tumors to reduce tumor size. This is called neoadjuvant CT (NAC). It has traditionally been used to treat CRLM which occurs as the cancer spreads to the liver. NAC can also cause side effects which can delay surgery. Proper timing of CRLM surgery is important to reduce these effects. Surgery after 4 weeks from the last dose of NAC is currently recommended. However, the optimal timing of surgery for the best outcomes is still not clear.

The study analyzed the records of 101 patients with CRLM 101 who received NAC followed by surgical removal of liver metastases. They were divided based on time until surgery (TTS) after NAC. 27 patients received surgery within 5 weeks (low-TTS) and 74 received beyond 5 weeks (high-TTS). They were followed up for 44 months on average.

There was no liver failure and TTS did not affect surgical complications. A pathological response (PatR) is the disappearance of all cancer cells as assessed by tissue pathology. 75.7% of patients in the low-TTS and 48.1% of patients in the high-TTS group had a favorable PatR. Patients with a lower TTS had 3.397 times higher chances of having a favorable PatR compared to higher TTS.

The average time until cancer progressed was significantly higher for the low-TTS group (16 months) compared to the high-TTS group (7 months). The average overall survival was 36 months for the high-TTS group and was still ongoing after 44 months in the low-TTS group.

The authors concluded that a TTS beyond 5 weeks after completing NAC may negatively impact the outcomes of patients with CRLM.

This study looked back in time to analyze patients’ data. Its results need to be confirmed in a real-time clinical trial.