The liver-first approach for synchronous colorectal liver metastases: more than a decade of experience in a single centre

Mechteld C. de Jong*, Rianne C. J. Beckers, Victor van Woerden, Julie M. L. Sijmons, Marc H. A. Bemelmans, Ronald M. van Dam, Cornelis H. C. Dejong

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: The feasibility of the liver-first approach for synchronous colorectal liver metastases (CRLM) has been established. We sought to assess the short-term and long-term outcomes for these patients.

Methods: Outcomes of patients who underwent a liver-first approach for CRLM between 2005 and 2015 were retrospectively evaluated from a prospective database.

Results: Of the 92 patients planned to undergo the liver-first strategy, the paradigm could be completed in 76.1%. Patients with concurrent extrahepatic disease failed significantly more often in completing the protocol (67% versus 21%; p = 0.03). Postoperative morbidity and mortality were 31.5% and 3.3% following liver resection and 30.9% and 0% after colorectal surgery. Of the 70 patients in whom the paradigm was completed, 36 patients (51.4%) developed recurrent disease after a median interval of 20.9 months. The median overall survival on an intention-to-treat basis was 33.1 months (3-and 5-year overall survival: 48.5% and 33.1%). Patients who were not able to complete their therapeutic paradigm had a significantly worse overall outcome (p = 0.03).

Conclusion: The liver-first approach is feasible with acceptable perioperative morbidity and mortality rates. Despite the considerable overall-survival-benefit, recurrence rates remain high. Future research should focus on providing selection tools to enable the optimal treatment sequence for each patient with synchronous CRLM.

Original languageEnglish
Pages (from-to)631-640
Number of pages10
JournalHPB
Volume20
Issue number7
DOIs
Publication statusPublished - Jul 2018

Keywords

  • HEPATIC METASTASES
  • RECTAL-CANCER
  • ENHANCED RECOVERY
  • RESECTION
  • SURGERY
  • MANAGEMENT
  • HEPATECTOMY
  • STRATEGIES
  • CARCINOMA
  • SURVIVAL

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