Perioperative aspects of resection for colorectal liver metastases. Quality of life, performance status and incisional hernia .

BackgroundLiver metastases are a common consequence of colorectal cancer. When feasible, surgical resection is first-line treatment. Synchronous disease can be treated with different strategies. Traditionally, the primary tumour is resected first followed by resection of the liver metastases (bowel-first). The other option, which is increasing, is the liver-first strategy, where resection of the liver is followed by resection of the primary cancer. Patients with metachronous disease are resected upfront. All surgical strategies are combined with perioperative chemotherapy. The impact of preoperative quality of life (QoL) has not yet been analyzed for these different groups, neither has symptoms related to Incisional hernia (IH) which is a common complication after surgery. Performance status (PS) is known as one of the strongest prognostic factors for survival in metastatic colorectal cancer.Questions/methodsI. Investigate incidence, location and risk factors for IH after resection for colorectal liver metastases (CRLM) including the use of chemotherapy.II. Analyze factors associated with poor PS after resection for CRLM and the impact on survival.III. Analyze whether preoperative QoL differs between patients undergoing the liver-firstor bowel-first strategy for synchronous CRLM, and patients resected formetachronous CRLM.IV. Investigate the clinical significance of IH, QoL, abdominal wall (AW) symptoms and their determinants.Results/ConclusionsIncidence rate for IH after liver surgery was as high as 30-43%. Hernia locations were midline alone in 86% of cases. Preoperative bevacizumab and previous IH were found to be independent risk factors. There were no differences regarding AW symptoms and QoL between the IH and non-IH groups. Nevertheless half of the patients experienced AW symptoms in long term but it was not related to IH. Patients with postoperative PS > 2 who did not receive adjuvant chemotherapy had decreased survival after resection for CRLM. After recurrence, a large majority of these patients had had improvement in PS allowing for administration of tumor specific treatment. PS was the strongest independent factor predicting survival. The patients in the liver-first group in no dimension reported a decreased preoperative QoL as compared to patients in the bowel-first and comparable QoL with the metachronous group