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Open Access 01-12-2021 | Metastasis | Hepatobiliary Tumors

Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry

Authors: Felice Giuliante, MD, Luca Viganò, MD, PhD, Agostino M. De Rose, MD, PhD, Darius F. Mirza, MD, PhD, Réal Lapointe, MD, Gernot Kaiser, MD, Eduardo Barroso, MD, Alessandro Ferrero, MD, Helena Isoniemi, MD, Santiago Lopez-Ben, MD, Irinel Popescu, MD, Jean-Francois Ouellet, MD, Catherine Hubert, MD, Jean-Marc Regimbeau, MD, Jen-Kou Lin, MD, Oleg G. Skipenko, MD, Francesco Ardito, MD, PhD, René Adam, MD

Published in: Annals of Surgical Oncology | Issue 13/2021

Abstract

Background

The liver-first approach in patients with synchronous colorectal liver metastases (CRLM) has gained wide consensus but its role is still to be clarified. We aimed to elucidate the outcome of the liver-first approach and to identify patients who benefit at most from this approach.

Methods

Patients with synchronous CRLM included in the LiverMetSurvey registry between 2000 and 2017 were considered. Three strategies were analyzed, i.e. liver-first approach, colorectal resection followed by liver resection (primary-first), and simultaneous resection, and three groups of patients were analyzed, i.e. solitary metastasis, multiple unilobar CRLM, and multiple bilobar CRLM. In each group, patients from the three strategy groups were matched by propensity score analysis.

Results

Overall, 7360 patients were analyzed: 4415 primary-first, 552 liver-first, and 2393 simultaneous resections. Compared with the other groups, the liver-first group had more rectal tumors (58.0% vs. 31.2%) and higher hepatic tumor burden (more than three CRLMs: 34.8% vs. 24.0%; size > 50 mm: 35.6% vs. 22.8%; p < 0.001). In patients with solitary and multiple unilobar CRLM, survival was similar regardless of treatment strategy, whereas in patients with multiple bilobar metastases, the liver-first approach was an independent positive prognostic factor, both in unmatched patients (3-year survival 65.9% vs. primary-first 60.4%: hazard ratio [HR] 1.321, p = 0.031; vs. simultaneous resections 54.4%: HR 1.624, p < 0.001) and after propensity score matching (vs. primary-first: HR 1.667, p = 0.017; vs. simultaneous resections: HR 2.278, p = 0.003).

Conclusion

In patients with synchronous CRLM, the surgical strategy should be decided according to the hepatic tumor burden. In the presence of multiple bilobar CRLM, the liver-first approach is associated with longer survival than the alternative approaches and should be evaluated as standard.

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Title: Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry
Authors: Felice Giuliante, MD
Luca Viganò, MD, PhD
Agostino M. De Rose, MD, PhD
Darius F. Mirza, MD, PhD
Réal Lapointe, MD
Gernot Kaiser, MD
Eduardo Barroso, MD
Alessandro Ferrero, MD
Helena Isoniemi, MD
Santiago Lopez-Ben, MD
Irinel Popescu, MD
Jean-Francois Ouellet, MD
Catherine Hubert, MD
Jean-Marc Regimbeau, MD
Jen-Kou Lin, MD
Oleg G. Skipenko, MD
Francesco Ardito, MD, PhD
René Adam, MD
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Metastasis
Liver Resection
Liver Resection
Published in: Annals of Surgical Oncology / Issue 13/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-021-10220-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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