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

• Published in: HPB (Oxford, England) Vol. 20; no. 7; pp. 631 - 640
• Main Authors: de Jong, Mechteld C., Beckers, Rianne C.J., van Woerden, Victor, Sijmons, Julie M.L., Bemelmans, Marc H.A., van Dam, Ronald M., Dejong, Cornelis H.C.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2018
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemoradiotherapy, Adjuvant; Colectomy - adverse effects; Colectomy - mortality; Colorectal Neoplasms - diagnostic imaging; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Databases, Factual; Female; Hepatectomy - adverse effects; Hepatectomy - mortality; Humans; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Netherlands; Retrospective Studies; Risk Factors; Time Factors; Time-to-Treatment; Treatment Outcome; Netherlands
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1016/j.hpb.2018.01.005

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