Liver resection following neoadjuvant immunotherapy: a single center retrospective study

Liver resection remains an important treatment approach in both primary and metastatic liver malignancies. However, the impact of neoadjuvant immune checkpoint inhibitor (ICI) therapy on surgical outcomes remains incompletely explored. This study aimed to evaluate safety and surgical and oncological outcomes of liver resections after neoadjuvant immunotherapy. This retrospective single-institution analysis included a total of 20 patients receiving immunotherapy (Pembrolizumab, Durvalumab or Atezolizumab) prior to hepatic resection at Mayo Clinic Rochester from February 2019 until October 2023. Surgical outcomes as well as radiological and pathological response were assessed. A total of 20 patients were identified. The cohort comprised primary liver cancer (n = 5), colorectal cancer liver metastasis (CRLM) (n = 4), and non-CRLM (n = 11). Overall, severe postoperative morbidity was observed in 4 patients, with 2 cases of post hepatectomy liver failure (PHLF Grade B) and no postoperative mortality within 90 days. Histopathological examination delineated complete pathological response (pCR) response in 10 out of 16 evaluated patients, of whom one experienced recurrence within our follow-up period. Radiological response did not correlate with pathological response. Neoadjuvant ICI therapy showed excellent pathological response rates in highly selected patients, while maintaining surgical safety and expected postoperative morbidity. Standard radiological assessment appears to be insufficient to predict pCR.