BACKGROUND: Management of patients with synchronous colorectal liver metastases (SCRLM) should be individually tailored. This study compares patients managed by hepatobiliary centers from diagnosis with those referred for liver resection (LR). METHODS: Between 1998 and 2010, a total of 284 patients with SCRLM underwent resection; 106 resectable patients (1-3 unilobar metastases, diameter <100 mm, liver-only disease) were divided into two groups: 66 managed from diagnosis (group A) and 40 referred for LR (group B). RESULTS: Group A contained a greater proportion of multiple metastases (55.0 vs. 34.8%, P = 0.042). Group B always received colorectal surgery as up-front treatment (vs. 18.2%, P < 0.0001). In group B, chemotherapy before LR was more common (72.5 vs. 33.3%, P = 0.0001) and lasted longer (P = 0.010). More patients in group B exhibited disease progression before LR (17.5 vs. 3.0%, P = 0.025). Group A underwent fewer surgical procedures (80.3% simultaneous resection vs. 0%, P < 0.00001), with similar short-term outcomes. After a median follow-up of 42.0 months, group A exhibited higher 5 year disease-free survival (DFS, 64.8 vs. 30.8%, P = 0.005) and fewer extrahepatic recurrences (21.5 vs. 47.5%, P = 0.005). The late-referral group (>6 months, n = 24) had shorter median overall survival (OS) and DFS than group A (49.1 and 25.3 months vs. not achieved and not achieved, P < 0.05). The early-referral group exhibited OS and DFS similar to group A. Multivariate analysis confirmed late referral as a negative predictive factor of OS and DFS. CONCLUSIONS: Monocentric management of SCRLM in hepatobiliary centers is associated with shorter preoperative chemotherapy, better disease control, fewer surgical procedures (simultaneous resection), and, compared with late-referred patients, better survival.
BACKGROUND: Management of patients with synchronous colorectal liver metastases (SCRLM) should be individually tailored. This study compares patients managed by hepatobiliary centers from diagnosis with those referred for liver resection (LR). METHODS: Between 1998 and 2010, a total of 284 patients with SCRLM underwent resection; 106 resectable patients (1-3 unilobar metastases, diameter <100 mm, liver-only disease) were divided into two groups: 66 managed from diagnosis (group A) and 40 referred for LR (group B). RESULTS: Group A contained a greater proportion of multiple metastases (55.0 vs. 34.8%, P = 0.042). Group B always received colorectal surgery as up-front treatment (vs. 18.2%, P < 0.0001). In group B, chemotherapy before LR was more common (72.5 vs. 33.3%, P = 0.0001) and lasted longer (P = 0.010). More patients in group B exhibited disease progression before LR (17.5 vs. 3.0%, P = 0.025). Group A underwent fewer surgical procedures (80.3% simultaneous resection vs. 0%, P < 0.00001), with similar short-term outcomes. After a median follow-up of 42.0 months, group A exhibited higher 5 year disease-free survival (DFS, 64.8 vs. 30.8%, P = 0.005) and fewer extrahepatic recurrences (21.5 vs. 47.5%, P = 0.005). The late-referral group (>6 months, n = 24) had shorter median overall survival (OS) and DFS than group A (49.1 and 25.3 months vs. not achieved and not achieved, P < 0.05). The early-referral group exhibited OS and DFS similar to group A. Multivariate analysis confirmed late referral as a negative predictive factor of OS and DFS. CONCLUSIONS: Monocentric management of SCRLM in hepatobiliary centers is associated with shorter preoperative chemotherapy, better disease control, fewer surgical procedures (simultaneous resection), and, compared with late-referred patients, better survival.
Authors: Christopher R Shubert; Elizabeth B Habermann; John R Bergquist; Cornelius A Thiels; Kristine M Thomsen; Walter K Kremers; Michael L Kendrick; Robert R Cima; David M Nagorney Journal: J Gastrointest Surg Date: 2015-08-04 Impact factor: 3.452