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Background <p>The optimal timing of resection for colorectal liver metastases (CRLM) after systemic therapy remains unclear. This study evaluated the impact of time-to-surgery (TTS) on postoperative morbidity and oncologic outcomes.</p> Methods <p>In this retrospective cohort (2018–2022) from a German high-volume hepatobiliary center, 159 patients underwent hepatic resection for CRLM following systemic therapy. Patients were stratified by TTS ≤ 41 versus ≥ 42 days. The primary endpoint was clinically meaningful postoperative morbidity (Comprehensive Complication Index ≥ 30). Secondary endpoints included liver-specific recurrence-free survival (RFS) and overall survival (OS). Multivariable regression, Cox proportional-hazards models, and prespecified subgroup analyses were performed.</p> Results <p>CCI ≥ 30 occurred in 48.7% of patients with shorter TTS versus 31.3% with longer TTS (<i>P</i> = 0.023). After multivariable adjustment, TTS ≥ 42 days was independently associated with lower odds of postoperative morbidity (OR 0.355; 95% CI 0.127–0.992; <i>P</i> = 0.048). In the subgroup of major hepatectomies, TTS ≥ 42 days demonstrated an even more pronounced protective effect (OR 0.069; 95% CI 0.006–0.778; <i>P</i> = 0.031). However, TTS ≥ 42 days was not independently associated with liver-specific RFS or OS.</p> Conclusion <p>Delaying surgery to ≥ 6 weeks after neoadjuvant systemic therapy was associated with significantly reduced postoperative morbidity without evidence of impaired early oncologic outcomes among patients who ultimately underwent resection. These findings support consideration of a prolonged interval before complex hepatectomy while highlighting the need for prospective validation.</p>

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Delaying surgery beyond six weeks after systemic therapy reduces postoperative morbidity without evidence of impaired oncologic outcomes in colorectal liver metastases

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月30日

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  • Esther Giehl-Brown,
  • Rajan Nikbakhsh,
  • Ana Mansourkiaei,
  • Laila Jötten,
  • Bruno Christian Köhler,
  • Thomas Longerich,
  • Bo Kong,
  • Arianeb Mehrabi,
  • Markus W Büchler,
  • Mohammed Al-Saeedi,
  • Christoph Kahlert

摘要

Background

The optimal timing of resection for colorectal liver metastases (CRLM) after systemic therapy remains unclear. This study evaluated the impact of time-to-surgery (TTS) on postoperative morbidity and oncologic outcomes.

Methods

In this retrospective cohort (2018–2022) from a German high-volume hepatobiliary center, 159 patients underwent hepatic resection for CRLM following systemic therapy. Patients were stratified by TTS ≤ 41 versus ≥ 42 days. The primary endpoint was clinically meaningful postoperative morbidity (Comprehensive Complication Index ≥ 30). Secondary endpoints included liver-specific recurrence-free survival (RFS) and overall survival (OS). Multivariable regression, Cox proportional-hazards models, and prespecified subgroup analyses were performed.

Results

CCI ≥ 30 occurred in 48.7% of patients with shorter TTS versus 31.3% with longer TTS (P = 0.023). After multivariable adjustment, TTS ≥ 42 days was independently associated with lower odds of postoperative morbidity (OR 0.355; 95% CI 0.127–0.992; P = 0.048). In the subgroup of major hepatectomies, TTS ≥ 42 days demonstrated an even more pronounced protective effect (OR 0.069; 95% CI 0.006–0.778; P = 0.031). However, TTS ≥ 42 days was not independently associated with liver-specific RFS or OS.

Conclusion

Delaying surgery to ≥ 6 weeks after neoadjuvant systemic therapy was associated with significantly reduced postoperative morbidity without evidence of impaired early oncologic outcomes among patients who ultimately underwent resection. These findings support consideration of a prolonged interval before complex hepatectomy while highlighting the need for prospective validation.