Neoadjuvant Chemotherapy for Initially Resectable Metachronous Colorectal Cancer Liver Metastases Is Associated With Early Postoperative Relapse

Background/Aim: The role of neoadjuvant chemotherapy (NAC) in treating initially resectable colorectal cancer liver metastases (CRCLM) remains controversial. Patients and Methods: We retrospectively compared outcomes between patients who underwent upfront surgery and those who received NAC followed by curative CRCLM surgery. Factors associated with early relapse were also investigated. Fifty-three patients were included (upfront surgery: n=31, NAC: n=22). Results: The 3-year overall survival (OS) and relapse-free survival (RFS) rates were comparable between the upfront surgery and NAC groups [OS: 83.9% vs. 81.8%, p=0.9, hazard ratio (HR)=1.07; RFS: 58.1% vs. 36.4%, p=0.1, HR=1.87]. However, among metachronous CRCLM cohorts, the 3-year OS rates were 88.2% and 90.0% (p=0.9, HR=0.85), and the 3-year RFS rates were 76.4% and 30.0% (p=0.015, HR=4.03), respectively. Patients with higher computed tomography values in CRCLM had significantly better RFS than those with lower values (p=0.04). Conversely, a higher number of CRCLM after NAC was significantly correlated with shorter RFS (p=0.007). Conclusion: Routine NAC for initially resectable metachronous CRCLM should be avoided because of the high risk of early relapse.