Timing of surgery in patients with synchronous colorectal cancer liver metastases undergoing neoadjuvant chemotherapy: a propensity score analysis

Background The optimal timing of surgery after neoadjuvant chemotherapy (NAC) in patients with synchronous colorectal cancer liver metastases (SLM) remains controversial. We plan to analyze whether the choice of different surgical timings will have different effects on the perioperative and oncologic outcomes of patients.Method We retrospectively collected all patients who met the inclusion and exclusion criteria from 2010 to 2020 in West China Hospital. Patients were grouped according to time interval (TI) after NAC to surgery. The perioperative and oncologic outcomes of the two groups were compared after propensity score matching. Univariate and multivariate analyzes were used to screen factors associated with prognosis.Result Among 255 enrolled patients, 188 were matched with comparable baseline (94 each group). Patients in the 6?TI?8 group had longer operation time, less intraoperative blood loss, and less postoperative complications than those in the 4?TI < 6 group. However, the overall survival (OS) (p = 0.012) and disease-free survival (DFS) (p = 0.013) of the patients in the 4?TI < 6 group were better than those in the 6?TI?8 group. Subgroup analysis found that the above conclusions still apply in age = 60, non-anemic patients, and patients who underwent R0 resection. OS was inversely correlated with TI in patients without preoperative jaundice. DFS was negatively correlated with TI in patients with preoperative jaundice. Multivariate analysis showed that the prolongation of TI after NAC to surgery was an independent prognostic risk factor for OS and DFS.Conclusions Patients with SLM may be a better choice for surgery within 4-6 weeks after receiving NAC. Although patients with SLM undergoing surgery 4-6 weeks after NAC has a higher rate of postoperative complications, radical is still recommended for a better survival benefit.

Automated summary

This study retrospectively analyzed patients with synchronous colorectal cancer liver metastases who underwent neoadjuvant chemotherapy followed by surgery. The patients were divided into two groups based on the timing of surgery after chemotherapy, and the perioperative and oncologic outcomes were compared. The results showed that surgery within 4-6 weeks after neoadjuvant chemotherapy had fewer postoperative complications but lower long-term survival rates and disease-free survival rates, indicating that early surgery may still be a better choice for patients with synchronous colorectal cancer liver metastases.