Short-Term Outcomes of Secondary Liver Surgery for Initially Unresectable Colorectal Liver Metastases Following Modern Induction Systemic Therapy in the Dutch CAIRO5 Trial
Objective:. To present short-term outcomes of liver surgery in patients with initially unresectable colorectal liver metastases (CRLM) downsized by chemotherapy plus targeted agents. Background:. The increase of complex hepatic resections of CRLM, technical innovations pushing boundaries of respecta...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health
2021-09-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000081 |
| _version_ | 1827856013826457600 |
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| author | Karen Bolhuis, MD Lodi Grosheide, MD Nina J. Wesdorp, MD Aysun Komurcu, MSc Thiery Chapelle, MD, PhD Cornelis H. C. Dejong, MD, PhD Michael F. Gerhards, MD, PhD Dirk J. Grünhagen, MD, PhD Thomas M. van Gulik, MD, PhD Joost Huiskens, MD, PhD Koert P. De Jong, MD, PhD Geert Kazemier, MD, PhD Joost M. Klaase, MD, PhD Mike S. L. Liem, MD, PhD I. Quintus Molenaar, MD, PhD Gijs A. Patijn, MD, PhD Arjen M. Rijken, MD, PhD Theo M. Ruers, MD, PhD Cornelis Verhoef, MD, PhD Johannes H. W. de Wilt, MD, PhD Cornelis J. A. Punt, MD, PhD Rutger-Jan Swijnenburg, MD, PhD for the Dutch Colorectal Cancer Group Liver Expert Panel |
| author_facet | Karen Bolhuis, MD Lodi Grosheide, MD Nina J. Wesdorp, MD Aysun Komurcu, MSc Thiery Chapelle, MD, PhD Cornelis H. C. Dejong, MD, PhD Michael F. Gerhards, MD, PhD Dirk J. Grünhagen, MD, PhD Thomas M. van Gulik, MD, PhD Joost Huiskens, MD, PhD Koert P. De Jong, MD, PhD Geert Kazemier, MD, PhD Joost M. Klaase, MD, PhD Mike S. L. Liem, MD, PhD I. Quintus Molenaar, MD, PhD Gijs A. Patijn, MD, PhD Arjen M. Rijken, MD, PhD Theo M. Ruers, MD, PhD Cornelis Verhoef, MD, PhD Johannes H. W. de Wilt, MD, PhD Cornelis J. A. Punt, MD, PhD Rutger-Jan Swijnenburg, MD, PhD for the Dutch Colorectal Cancer Group Liver Expert Panel |
| author_sort | Karen Bolhuis, MD |
| collection | DOAJ |
| description | Objective:. To present short-term outcomes of liver surgery in patients with initially unresectable colorectal liver metastases (CRLM) downsized by chemotherapy plus targeted agents.
Background:. The increase of complex hepatic resections of CRLM, technical innovations pushing boundaries of respectability, and use of intensified induction systemic regimens warrant for safety data in a homogeneous multicenter prospective cohort.
Methods:. Patients with initially unresectable CRLM, who underwent complete resection after induction systemic regimens with doublet or triplet chemotherapy, both plus targeted therapy, were selected from the ongoing phase III CAIRO5 study (NCT02162563). Short-term outcomes and risk factors for severe postoperative morbidity (Clavien Dindo grade ≥ 3) were analyzed using logistic regression analysis.
Results:. A total of 173 patients underwent resection of CRLM after induction systemic therapy. The median number of metastases was 9 and 161 (93%) patients had bilobar disease. Thirty-six (20.8%) 2-stage resections and 88 (51%) major resections (>3 liver segments) were performed. Severe postoperative morbidity and 90-day mortality was 15.6% and 2.9%, respectively. After multivariable analysis, blood transfusion (odds ratio [OR] 2.9 [95% confidence interval (CI) 1.1–6.4], P = 0.03), major resection (OR 2.9 [95% CI 1.1–7.5], P = 0.03), and triplet chemotherapy (OR 2.6 [95% CI 1.1–7.5], P = 0.03) were independently correlated with severe postoperative complications. No association was found between number of cycles of systemic therapy and severe complications (r = −0.038, P = 0.31).
Conclusion:. In patients with initially unresectable CRLM undergoing modern induction systemic therapy and extensive liver surgery, severe postoperative morbidity and 90-day mortality were 15.6% and 2.7%, respectively. Triplet chemotherapy, blood transfusion, and major resections were associated with severe postoperative morbidity. |
| first_indexed | 2024-03-12T12:19:36Z |
| format | Article |
| id | doaj.art-5e754ce85cf045fbad154fecb26942d0 |
| institution | Directory Open Access Journal |
| issn | 2691-3593 |
| language | English |
| last_indexed | 2024-03-12T12:19:36Z |
| publishDate | 2021-09-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj.art-5e754ce85cf045fbad154fecb26942d02023-08-30T06:08:53ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932021-09-0123e08110.1097/AS9.0000000000000081202109000-00008Short-Term Outcomes of Secondary Liver Surgery for Initially Unresectable Colorectal Liver Metastases Following Modern Induction Systemic Therapy in the Dutch CAIRO5 TrialKaren Bolhuis, MD0Lodi Grosheide, MD1Nina J. Wesdorp, MD2Aysun Komurcu, MSc3Thiery Chapelle, MD, PhD4Cornelis H. C. Dejong, MD, PhD5Michael F. Gerhards, MD, PhD6Dirk J. Grünhagen, MD, PhD7Thomas M. van Gulik, MD, PhD8Joost Huiskens, MD, PhD9Koert P. De Jong, MD, PhD10Geert Kazemier, MD, PhD11Joost M. Klaase, MD, PhD12Mike S. L. Liem, MD, PhD13I. Quintus Molenaar, MD, PhD14Gijs A. Patijn, MD, PhD15Arjen M. Rijken, MD, PhD16Theo M. Ruers, MD, PhD17Cornelis Verhoef, MD, PhD18Johannes H. W. de Wilt, MD, PhD19Cornelis J. A. Punt, MD, PhD20Rutger-Jan Swijnenburg, MD, PhD21for the Dutch Colorectal Cancer Group Liver Expert PanelFrom the * Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The NetherlandsFrom the * Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands† Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam, The Netherlands‡ The Netherlands Netherlands Comprehensive Cancer Center, Utrecht, The Netherlands§ Department of Hepatobiliary, Transplantation, and Endocrine Surgery, University of Antwerp, Belgium‖ Maastricht University Medical Center, Department of Surgery, Maastricht, The Netherlands and Universitätsklinikum Aachen, Aachen, Germany¶ Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands# Erasmus MC Cancer Institute, Department of Surgery, Rotterdam, The Netherlands** Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands†† SAS Institute B.V., Huizen, The Netherlands‡‡ Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen† Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam, The Netherlands‡‡ Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen§§ Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands‖‖ Regional Academic Cancer Center Utrecht, Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, The Netherlands¶¶ Department of Surgery, Isala, Zwolle, The Netherlands## Amphia hospital, Department of Surgery, Breda, The Netherlands## Amphia hospital, Department of Surgery, Breda, The Netherlands# Erasmus MC Cancer Institute, Department of Surgery, Rotterdam, The Netherlands*** Radboud University Medical Center, Department of Surgery, Nijmegen, The NetherlandsFrom the * Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands** Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The NetherlandsObjective:. To present short-term outcomes of liver surgery in patients with initially unresectable colorectal liver metastases (CRLM) downsized by chemotherapy plus targeted agents. Background:. The increase of complex hepatic resections of CRLM, technical innovations pushing boundaries of respectability, and use of intensified induction systemic regimens warrant for safety data in a homogeneous multicenter prospective cohort. Methods:. Patients with initially unresectable CRLM, who underwent complete resection after induction systemic regimens with doublet or triplet chemotherapy, both plus targeted therapy, were selected from the ongoing phase III CAIRO5 study (NCT02162563). Short-term outcomes and risk factors for severe postoperative morbidity (Clavien Dindo grade ≥ 3) were analyzed using logistic regression analysis. Results:. A total of 173 patients underwent resection of CRLM after induction systemic therapy. The median number of metastases was 9 and 161 (93%) patients had bilobar disease. Thirty-six (20.8%) 2-stage resections and 88 (51%) major resections (>3 liver segments) were performed. Severe postoperative morbidity and 90-day mortality was 15.6% and 2.9%, respectively. After multivariable analysis, blood transfusion (odds ratio [OR] 2.9 [95% confidence interval (CI) 1.1–6.4], P = 0.03), major resection (OR 2.9 [95% CI 1.1–7.5], P = 0.03), and triplet chemotherapy (OR 2.6 [95% CI 1.1–7.5], P = 0.03) were independently correlated with severe postoperative complications. No association was found between number of cycles of systemic therapy and severe complications (r = −0.038, P = 0.31). Conclusion:. In patients with initially unresectable CRLM undergoing modern induction systemic therapy and extensive liver surgery, severe postoperative morbidity and 90-day mortality were 15.6% and 2.7%, respectively. Triplet chemotherapy, blood transfusion, and major resections were associated with severe postoperative morbidity.http://journals.lww.com/10.1097/AS9.0000000000000081 |
| spellingShingle | Karen Bolhuis, MD Lodi Grosheide, MD Nina J. Wesdorp, MD Aysun Komurcu, MSc Thiery Chapelle, MD, PhD Cornelis H. C. Dejong, MD, PhD Michael F. Gerhards, MD, PhD Dirk J. Grünhagen, MD, PhD Thomas M. van Gulik, MD, PhD Joost Huiskens, MD, PhD Koert P. De Jong, MD, PhD Geert Kazemier, MD, PhD Joost M. Klaase, MD, PhD Mike S. L. Liem, MD, PhD I. Quintus Molenaar, MD, PhD Gijs A. Patijn, MD, PhD Arjen M. Rijken, MD, PhD Theo M. Ruers, MD, PhD Cornelis Verhoef, MD, PhD Johannes H. W. de Wilt, MD, PhD Cornelis J. A. Punt, MD, PhD Rutger-Jan Swijnenburg, MD, PhD for the Dutch Colorectal Cancer Group Liver Expert Panel Short-Term Outcomes of Secondary Liver Surgery for Initially Unresectable Colorectal Liver Metastases Following Modern Induction Systemic Therapy in the Dutch CAIRO5 Trial Annals of Surgery Open |
| title | Short-Term Outcomes of Secondary Liver Surgery for Initially Unresectable Colorectal Liver Metastases Following Modern Induction Systemic Therapy in the Dutch CAIRO5 Trial |
| title_full | Short-Term Outcomes of Secondary Liver Surgery for Initially Unresectable Colorectal Liver Metastases Following Modern Induction Systemic Therapy in the Dutch CAIRO5 Trial |
| title_fullStr | Short-Term Outcomes of Secondary Liver Surgery for Initially Unresectable Colorectal Liver Metastases Following Modern Induction Systemic Therapy in the Dutch CAIRO5 Trial |
| title_full_unstemmed | Short-Term Outcomes of Secondary Liver Surgery for Initially Unresectable Colorectal Liver Metastases Following Modern Induction Systemic Therapy in the Dutch CAIRO5 Trial |
| title_short | Short-Term Outcomes of Secondary Liver Surgery for Initially Unresectable Colorectal Liver Metastases Following Modern Induction Systemic Therapy in the Dutch CAIRO5 Trial |
| title_sort | short term outcomes of secondary liver surgery for initially unresectable colorectal liver metastases following modern induction systemic therapy in the dutch cairo5 trial |
| url | http://journals.lww.com/10.1097/AS9.0000000000000081 |
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