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Resection of colorectal liver metastases after second-line chemotherapy: is it worthwhile? A LiverMetSurvey analysis of 6415 patients

European Journal of Cancer, June 2017, Pages 7 - 15



Patient outcome after resection of colorectal liver metastases (CLM) following second-line preoperative chemotherapy (PCT) performed for insufficient response or toxicity of the first-line, is little known and has here been compared to the outcome following first-line.

Patients and methods

From January 2005 to June 2013, 5624 and 791 consecutive patients of a prospective international cohort received 1 and 2 PCT lines before CLM resection (group 1 and 2, respectively). Survival and prognostic factors were analysed.


After a mean follow-up of 30.1 months, there was no difference in survival from CLM diagnosis (median, 3-, and 5-year overall survival [OS]: 58.6 months, 76% and 49% in group 2 versus 58.9 months, 71% and 49% in group 1, respectively, P = 0.32). After hepatectomy, disease-free survival (DFS) was however shorter in group 2: 17.2 months, 27% and 15% versus 19.4 months, 32% and 23%, respectively (P = 0.001). Among the initially unresectable patients of group 1 and 2, no statistical difference in OS or DFS was observed. Independent predictors of worse OS in group 2 were positive primary lymph nodes, extrahepatic disease, tumour progression on second line, R2 resection and number of hepatectomies/year <50. Positive primary nodes, synchronous and bilateral metastases were predictors of shorter DFS. Initial unresectability did not impact OS or DFS in group 2.


CLM resection following second-line PCT, after oncosurgically favourable selection, could bring similar OS compared to what observed after first-line. For initially unresectable patients, OS or DFS is comparable between first- and second-line PCT. Surgery should not be denied after the failure of first-line chemotherapy.


  • A heavier tumour burden was found in patients with colorectal liver metastases (CLM) resection after 2nd-line preoperative chemotherapy (PCT).
  • The 49% 5-year overall survival (OS) from CLM diagnosis in this group was similar to that after 1st-line.
  • OS or disease-free survival was comparable for the subsets of initially unresectable of two PCT groups.
  • Surgery of CLM may be proposed to resect CLM ever after 2nd-line chemotherapy.

Keywords: Colorectal cancer, Liver metastasis, Preoperative chemotherapy, Second line, Hepatectomy.


a Hepatobiliary Center, AP-HP Hôpital Paul Brousse, Université Paris-Sud, Inserm U935, Villejuif, France

b Eastern Hepatobiliary Surgery Hospital/National Liver Cancer Center, Second Military Medical University, Shanghai, China

c Department of Oncology, AP-HP Hôpital Paul Brousse, Université Paris-Sud, Inserm U935, Villejuif, France

d Department of HPB Surgery and Transplantation, Curry Cabral Hospital, Lisbon, Portugal

e Department of Digestive Surgery, Hôpital Saint André, Bordeaux, France

f Hepatobiliary Surgery Unit, Agostino Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Italy

g Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy

h HPB Surgery and Transplantation Unit, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montréal, Montréal, Canada

i Department of Oncology and Digestive Surgery, CHU Amiens-Picardie, Amiens, France

j Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Dr. Josep Trueta Hospital, IdlBGi, Girona, Spain

k Department of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland

l Unit of HPB Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

m Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

n School of Medicine, National Yang-Ming University, Taipei, Taiwan

o Department of Surgery, Medical University of Vienna, General Hospital, Vienna, Austria

p Department of Oncologic Surgery, Institut Gustave Roussy, Villejuif, France

q Research Center of Surgery, Russian Academy of Medical Science, Moscow, Russia

r Division of Surgery A, Department of Surgery, GB Rossi Hospital, University of Verona, Verona, Italy

Corresponding author: Hepatobiliary Center, AP-HP Hôpital Paul Brousse, Université Paris-Sud, Inserm U935, 12 Avenue Paul Vaillant Couturier, 94804 Villejuif, France. Fax: +33 1 45 59 38 57.

1 These authors contributed equally to this work.

2 Current address: Cancer Chronotherapy Unit, Cancer Research Centre, Warwick Medical School, Warwick University, Coventry, Warwickshire, UK.

3 Current address: Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.