ORIGINAL ARTICLE Safety of hepatic resection for colorectal metastases in the era of neo-adjuvant chemotherapy Alessandro Cucchetti & Giorgio Ercolani & Matteo Cescon & Paolo Di Gioia & Eugenia Peri & Giovanni Brandi & Sara Pellegrini & Antonio Daniele Pinna Received: 5 September 2011 /Accepted: 8 December 2011 /Published online: 24 December 2011 # Springer-Verlag 2011 Abstract Purpose The relationship between neo-adjuvant chemothera- py prior to hepatectomy in patients with resectable colorectal liver metastases and post-operative morbidity still has to be clarified. Methods Data from 242 patients undergoing hepatectomy for colorectal liver metastases, judged resectable at first observation, were reviewed and their clinical outcome was related to neo-adjuvant chemotherapy (125 patients). Selec- tion biases were outlined and properly handled by means of propensity score analysis. Results Post-operative death was 1.2% and morbidity 40.9%. Pre-operative chemotherapy was only apparently related to higher morbidity (P 0 0.021): multivariate analysis identified extension of hepatectomy and intra-operative blood loss as independent prognostic variables (P <0.05). Patients receiving and not receiving neo-adjuvant chemotherapy were signifi- cantly different for several covariates, including extension of hepatectomy (P 0 0.049). After propensity score adjustment, 94 patients were identified as having similar covariate distribu- tion (standardized differences <|0.1|) except for neo-adjuvant treatment (47 patients for each group). In this matched sample, mortality was similar and post-operative complications were only slightly higher (hazard ratio 0 1.38) in treated patients. A significantly higher need for fluid replacement was only observed in patients receiving neo-adjuvant chemothera- py (P 0 0.038). Conclusions Neo-adjuvant chemotherapy showed a limited role in determining post-operative morbidity after hepatic resection and did not modify mortality. Keywords Hepatic resection . Chemotherapy . Colorectal neoplasm . Liver metastases . Morbidity Introduction Colorectal cancer is a leading cause of cancer-related mor- bidity and mortality worldwide [1, 2]. The liver is the most common site of metastases, observed in up to 25% of patients at the time of initial diagnosis and within 3 years after primary colonic surgery in more than 50% of stage III patients [3–5]. Neo-adjuvant chemotherapy has become an integral part of the multidisciplinary management of meta- static colorectal cancer. It can result in the down-staging of disease and thus improve hepatic resection rates by 13–20% [6, 7]. The practice of administering neo-adjuvant chemo- therapy in patients with resectable colorectal liver metastases has recently increased. This practice is aimed at assessing response to treatment, limiting the extent of liver resection, reducing R1 resection rates, and avoiding surgery in patients with rapidly progressive disease as a result of chemotherapy resistance, thereby improving patient selection [8]. The draw- backs include the potential induction of chemotherapy- associated steato-hepatitis and veno-occlusive changes that manifest as a mottled, friable, and hemorrhagic liver that Electronic supplementary material The online version of this article (doi:10.1007/s00423-011-0894-4) contains supplementary material, which is available to authorized users. A. Cucchetti (*) : G. Ercolani : M. Cescon : P. Di Gioia : E. Peri : S. Pellegrini : A. D. Pinna Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy e-mail: aleqko@libero.it G. Brandi Department of Hematology and Oncological Sciences, University of Bologna, Bologna, Italy Langenbecks Arch Surg (2012) 397:397–405 DOI 10.1007/s00423-011-0894-4