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

Background
Liver 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/methods
I. 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-first
or bowel-first strategy for synchronous CRLM, and patients resected for
metachronous CRLM.
IV. Investigate the clinical significance of IH, QoL, abdominal wall (AW) symptoms and
their determinants.
Results/Conclusions
Incidence 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.