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. 2022 Apr;74(2):451-465.
doi: 10.1007/s13304-021-01234-w. Epub 2022 Jan 17.

Which surgical strategy for colorectal cancer with synchronous hepatic metastases provides the best outcome? A comparison between primary first, liver first and simultaneous approach

Fabio Carbone  1   2 , Yinshan Chee  3 , Shahnawaz Rasheed  3 , David Cunningham  4 , Ricky Harminder Bhogal  5 , Long Jiao  5   6 , Paris Tekkis  3   7   6 , Christos Kontovounisios  3   7   6
Affiliations

Which surgical strategy for colorectal cancer with synchronous hepatic metastases provides the best outcome? A comparison between primary first, liver first and simultaneous approach

Fabio Carbone et al. Updates Surg. 2022 Apr.

Abstract

Background: There is no clear consensus about the best surgical strategy for patients with colorectal cancer (CRC) and synchronous liver metastases (SCRLM).

Methods: Between 2009 and 2019, patients with CRC and SCRLM considered for curative treatment were included. Perioperative and follow-up data were analysed to examine the safety and survival outcomes of primary first (PF), liver first (LF) and simultaneous resection (SR) strategies.

Results: 204 patients were identified, consisting of PF (n = 129), LF (n = 26) and SR (n = 49). Forty-five patients (22.1%) failed to have either the primary or the liver metastases resected following initial LF (n = 11, 42.3%) or PF (n = 34, 26.4%), respectively (p < 0.001). The postoperative morbidity rates were 31.0%, 38.4% and 40.8% in PF, LF and SR group, respectively (p = 0.409); the mortality rates were 2.3%, 0% and 4.1%, respectively (p = 0.547). The 1-, 3- and 5-year overall survival (OS) were 94%, 72%, 53% in the PF group, 74%, 54%, 36% in the LF group, and 91%, 74%, 63% in the SR group. LF group had the worst OS compared to PF and SR (p = 0.040, p = 0.052). The 1-, 3- and 5-year disease-free survival (DFS) were 31%, 15%, 10% in PF, 21%, 9% and 9% in LF and 45%, 28% and 28% in SR group, respectively. SR group had a better DFS compared to PF and LF (p = 0.005, p = 0.008). At the multivariate analysis, there was no difference between the three strategies in terms of OS (PF vs SR OS-HR 1.090, p = 0.808; LF vs SR OS-HR 1.582, p = 0.365) and the PF had a worse DFS compared to the SR approach (PF vs SR DFS-HR 1.803, p = 0.007; LF vs SR DFS-HR 1.252, p = 0.492).

Conclusions: PF, LF and SR had comparable postoperative morbidity and mortality. The three surgical strategies had similar OS outcomes. The PF strategy was associated with a worse DFS than SR, while the LF approach was associated with a high failure rate to progress to the second stage (primary tumour resection).

Keywords: Colorectal cancer; Liver first; Liver metastases; Multidisciplinary team (MDT); Primary first; Simultaneous resection.

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References

    1. Adam R, de Gramont A, Figueras J et al (2015) Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev 41(9):729–741 - DOI
    1. van der Pool AE, Damhuis RA, Ijzermans JN et al (2012) Trends in incidence, treatment and survival of patients with stage IV colorectal cancer: a population-based series. Colorectal Dis 14(1):56–61 - DOI
    1. Chow FC, Chok KS (2019) Colorectal liver metastases: an update on multidisciplinary approach. World J Hepatol 11(2):150–172 - DOI
    1. Wanis KN, Pineda-Solis K, Tun-Abraham ME et al (2017) Management of colorectal cancer with synchronous liver metastases: impact of multidisciplinary case conference review. Hepatobiliary Surg Nutr 6(3):162–169 - DOI
    1. Weledji EP (2017) Centralization of liver cancer surgery and impact on multidisciplinary teams working on stage IV colorectal cancer. Oncol Rev 11(2):331 - PubMed - PMC

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