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 language | English |
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Pages (from-to) | 631-640 |
Number of pages | 10 |
Journal | HPB |
Volume | 20 |
Issue number | 7 |
DOIs | |
Publication status | Published - Jul 2018 |
Keywords
- HEPATIC METASTASES
- RECTAL-CANCER
- ENHANCED RECOVERY
- RESECTION
- SURGERY
- MANAGEMENT
- HEPATECTOMY
- STRATEGIES
- CARCINOMA
- SURVIVAL