BACKGROUND: Liver resection before primary cancer resection is a novel strategy advocated for selected patients with synchronous colorectal liver metastases (sCRLM). This study measured outcomes in patients with sCRLM following a liver-first or classical approach, and used a validated propensity score. METHODS: Clinical, pathological and follow-up data were collected prospectively from consecutive patients undergoing hepatic resection for sCRLM at a single centre (2004-2014). Cumulative disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS) were calculated by means of Kaplan-Meier analysis. Survival differences were analysed in the whole cohort and in subgroups matched according to Basingstoke Predictive Index (BPI). RESULTS: Of 582 patients, 98 had a liver-first and 467 a classical approach to treatment; 17 patients undergoing simultaneous bowel and liver resection were excluded. The median (i.q.r.) BPI was significantly higher in the liver-first compared with the classical group: 8·5 (5-10) versus 8 (4-9) (P = 0·030). Median follow-up was 34 months. The 5-year DFS rate was lower in the liver-first group than in the classical group (23 versus 45·6 per cent; P = 0·001), but there was no difference in 5-year CSS (51 versus 53·8 per cent; P = 0·379) or OS (44 versus 49·6 per cent; P = 0·305). After matching for preoperative BPI, there was no difference in 5-year DFS (37 versus 41·2 per cent for liver-first versus classical approach; P = 0·083), CSS (51 versus 53·2 per cent; P = 0·616) or OS (47 versus 49·1 per cent; P = 0·846) rates. CONCLUSION: Patients with sCRLM selected for a liver-first approach had more oncologically advanced disease and a poorer prognosis. They had inferior cumulative DFS than those undergoing a classical approach, a difference negated by matching preoperative BPI.
BACKGROUND: Liver resection before primary cancer resection is a novel strategy advocated for selected patients with synchronous colorectal liver metastases (sCRLM). This study measured outcomes in patients with sCRLM following a liver-first or classical approach, and used a validated propensity score. METHODS: Clinical, pathological and follow-up data were collected prospectively from consecutive patients undergoing hepatic resection for sCRLM at a single centre (2004-2014). Cumulative disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS) were calculated by means of Kaplan-Meier analysis. Survival differences were analysed in the whole cohort and in subgroups matched according to Basingstoke Predictive Index (BPI). RESULTS: Of 582 patients, 98 had a liver-first and 467 a classical approach to treatment; 17 patients undergoing simultaneous bowel and liver resection were excluded. The median (i.q.r.) BPI was significantly higher in the liver-first compared with the classical group: 8·5 (5-10) versus 8 (4-9) (P = 0·030). Median follow-up was 34 months. The 5-year DFS rate was lower in the liver-first group than in the classical group (23 versus 45·6 per cent; P = 0·001), but there was no difference in 5-year CSS (51 versus 53·8 per cent; P = 0·379) or OS (44 versus 49·6 per cent; P = 0·305). After matching for preoperative BPI, there was no difference in 5-year DFS (37 versus 41·2 per cent for liver-first versus classical approach; P = 0·083), CSS (51 versus 53·2 per cent; P = 0·616) or OS (47 versus 49·1 per cent; P = 0·846) rates. CONCLUSION:Patients with sCRLM selected for a liver-first approach had more oncologically advanced disease and a poorer prognosis. They had inferior cumulative DFS than those undergoing a classical approach, a difference negated by matching preoperative BPI.
Authors: H Salvador-Rosés; S López-Ben; P Planellas; E Canals; M Casellas-Robert; R Farrés; E Ramos; A Codina-Cazador; J Figueras Journal: Clin Transl Oncol Date: 2017-07-13 Impact factor: 3.405
Authors: Francesco Esposito; Chetana Lim; Antonio Sa Cunha; Patrick Pessaux; Francis Navarro; Daniel Azoulay Journal: World J Surg Date: 2018-12 Impact factor: 3.352
Authors: C Lim; A Doussot; M Osseis; F Esposito; C Salloum; J Calderaro; C Tournigand; D Azoulay Journal: Clin Transl Oncol Date: 2018-03-28 Impact factor: 3.405
Authors: M G Besselink; M D'Hondt; P D Gobardhan; M J van der Poel; P J Tanis; H A Marsman; A M Rijken; E C Gertsen; S Ovaere; M F Gerhards Journal: Surg Endosc Date: 2018-08-01 Impact factor: 4.584
Authors: Valentinus T Valdimarsson; Ingvar Syk; Gert Lindell; Per Sandström; Bengt Isaksson; Magnus Rizell; Agneta Norén; Bjarne Ardnor; Christian Sturesson Journal: World J Surg Date: 2020-07 Impact factor: 3.352
Authors: Felice Giuliante; Luca Viganò; Agostino M De Rose; Darius F Mirza; Réal Lapointe; Gernot Kaiser; Eduardo Barroso; Alessandro Ferrero; Helena Isoniemi; Santiago Lopez-Ben; Irinel Popescu; Jean-Francois Ouellet; Catherine Hubert; Jean-Marc Regimbeau; Jen-Kou Lin; Oleg G Skipenko; Francesco Ardito; René Adam Journal: Ann Surg Oncol Date: 2021-07-01 Impact factor: 5.344