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Session: ePoster Monitor 5-Colon Cancer 4

eP338 - Neoadjuvant Chemotherapy Followed by Surgical Resection vs Upfront Surgery for Resectable Colorectal Cancer Liver Metastasis: A Systematic Review and Meta-Analysis

Sunday, June 2, 2024
11:09 AM – 11:14 AM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • Ivonne S. Zuniga, MD (she/her/hers)

    Medical Graduate
    Universidad Nacional Autónoma de Nicaragua, Managua
    Managua, Managua, Nicaragua

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • MP

    Mariana Pereira Silva, n/a

    Medical Student
    Escola Bahiana de Medicina e Saúde Pública EBMSP
    Salvador, Bahia, Brazil

    Disclosure information not submitted.

  • Rafael R H Martin, MD (he/him/his)

    Postdoctoral Research Fellow
    Beth Israel Deaconess Medical Center
    Boston, MA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • BO

    Bruna Oliveira Trindade, n/a

    Medical Student
    Universidade Federal de Ciências da Saúde de Porto Alegre
    Porto Alegre, Rio Grande do Sul, Brazil

    Disclosure information not submitted.

  • PM

    Patrícia Marcolin, n/a

    Medical Student
    Universidade Federal da Fronteira Sul
    Passo Fundo, Rio Grande do Sul, Brazil

    Disclosure information not submitted.

    • Senior Author(s)

  • Fernando Lambreton, MD

    Colorectal Surgery Fellow
    Baylor University Medical Center
    Dallas, TX, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

Purpose/Background: Systemic chemotherapy is the primary treatment for patients with unresectable colorectal cancer liver metastasis (CRLM). However, in resectable CRLM, the role of systemic chemotherapy is still controversial. We aim to evaluate the effects of neoadjuvant chemotherapy (NAC) for patients with resectable CRLM.Methods/Interventions: A comprehensive search of PubMed, Embase, and Cochrane databases was conducted for observational studies or randomized controlled trials (RCTs) comparing NAC with upfront surgery (UPS) for resectable CRLM. Studies that included initially unresectable or borderline resectable metastases were excluded. The primary outcomes were overall survival (OS), disease free survival (DFS) and progression free survival (PFS). The secondary outcomes were related to postoperative results. Heterogeneity was examined using I² statistics. Odds ratio (OR), hazard ratio (HR) and mean difference (MD) with 95% confidence interval (CI) were computed with the use of a random-effects model.Results/Outcomes: From a total of 5,103 studies, we included 23 studies, 21 observational and 2 RCTs, with 8,243 patients. NAC was used in 4121 (49.99%) of patients. Overall survival showed no statistical significant difference between groups (HR 1.01; 95% CI 0.83-1.22; p= 0.92; I²=64%; figure 1A), same as progression free survival (HR 0.93; 95% CI 0.77-1.14; P=0.50; I²=46%; figure 1B). Disease free survival showed that there is a statistically significant increased risk of disease recurrence with NAC compared with UPS (HR 1.21; 95% CI 1.11-1.32; p= < 0.0001; I²=0%; figure 1C). There was no statistically significant difference between groups regarding blood loss, intraoperative transfusion, perioperative transfusion, postoperative bleeding, surgical site infection, postoperative hospital length of stay and 30 day mortality. However, operating time (MD 15.63; 95% CI 2.30-28.95; p=0.02; I²=58%; figure 1D) was significantly longer in the NAC group compared with the UPS group.Conclusion/

Discussion: This comprehensive systematic review and meta analysis provides evidence that NAC does not provide a significant improvement in overall survival compared with UPS for resectable CRLM, however it was associated with increased risk of disease recurrence and longer operating times. More RCTs on the topic are required to further evaluate the effects of NAC on this population."Figure 1A - Overall Survival (OS)

Overall survival showed no statistical significant difference between NAC and UPS.
Figure 1B - Progression Free Survival (PFS)

Progression free survival showed no statistical significant difference between the groups.
Figure 1C - Disease Free Survival (DFS)

Disease free survival showed that there is a statistically significant increased risk of disease recurrence with NAC compared with UPS.
Figure 1D - Operating time

Operating time was significantly longer in the NAC group compared with the UPS group."