Karim Boudjema1, Clara Locher2, Charles Sabbagh3, Pablo Ortega-Deballon4, Bruno Heyd5, Philippe Bachellier6, Sylvie Métairie7, François Paye8, Pascal Bourlier9, René Adam10, Aude Merdrignac1, Christelle Tual2, Estelle Le Pabic2, Laurent Sulpice1, Bernard Meunier1, Jean-Marc Regimbeau3, Eric Bellissant2. 1. Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, Rennes, France. 2. Department of Clinical Pharmacology, University Hospital, Rennes 1 University, Rennes, France. 3. Department of Digestive Surgery, University Hospital, Amiens University, Amiens, France. 4. Department of Digestive Surgical Oncology, University Hospital, Bourgogne University, Dijon, France. 5. Department of Visceral, Digestive and Oncologic Surgery, University Hospital, Franche-Comté University, Besançon, France. 6. Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Hospital, Strasbourg University, Strasbourg, France. 7. Department of Hepatobiliary, Oncologic and Digestive Surgery, University Hospital, Nantes University, Nantes, France. 8. Department of Digestive and Hepato-Biliary Surgery, AP-HP, Saint-Antoine Hospital, Pierre et Marie Curie University, Paris, France. 9. Department of Digestive, Endocrine, Oncologic and Liver Transplant Surgery, University Hospital, François Rabelais University, Tours, France. 10. Department of Hepatobiliary, Oncologic and Transplant Surgery, AP-HP, Paul Brousse Hospital, Paris-Sud University, Villejuif, France.
Abstract
OBJECTIVE: To answer whether synchronous colorectal cancer liver metastases (SLM) should be resected simultaneously with primary cancer or should be delayed. SUMMARY BACKGROUND DATA: Numerous studies have compared both strategies. All were retrospective and conclusions were contradictory. METHODS:Adults with colorectal cancer and resectable SLM were randomly assigned to either simultaneous or delayed resection of the metastases. The primary outcome was the rate of major complications within 60 days following surgery. Secondary outcomes included overall and disease-free survival. RESULTS:A total of 105 patients were recruited. Eighty-five patients (39 and 46 in the simultaneous- and delayed-resection groups, respectively) were analyzed. The percentage of major perioperative complications did not differ between groups (49% and 46% in the simultaneous- and delayed-resection groups, respectively, adjusted OR 0.84, 95% CI 0.35-2.01; P = 0.70, logistic regression). Complications rates were 28% and 13% (P = 0.08, χ2 test) at colorectal site and 15% and 17% (P = 0.80, χ2 test) at liver site, in simultaneous- and delayed-resection groups, respectively. In the delayed-resection group, 8 patients did not reach the liver resection stage, and this was due to disease progression in 6 cases. After 2 years, overall and disease-free survival tended to be improved in simultaneous as compared with delayed-resection groups (P = 0.05), a tendency which persisted for OS after a median follow-up of 47 months. CONCLUSIONS:Complication rates did not appear to differ when colorectal cancer and synchronous liver metastases are resected simultaneously. Delayed resection tended to impair overall survival.
RCT Entities:
OBJECTIVE: To answer whether synchronous colorectal cancer liver metastases (SLM) should be resected simultaneously with primary cancer or should be delayed. SUMMARY BACKGROUND DATA: Numerous studies have compared both strategies. All were retrospective and conclusions were contradictory. METHODS: Adults with colorectal cancer and resectable SLM were randomly assigned to either simultaneous or delayed resection of the metastases. The primary outcome was the rate of major complications within 60 days following surgery. Secondary outcomes included overall and disease-free survival. RESULTS: A total of 105 patients were recruited. Eighty-five patients (39 and 46 in the simultaneous- and delayed-resection groups, respectively) were analyzed. The percentage of major perioperative complications did not differ between groups (49% and 46% in the simultaneous- and delayed-resection groups, respectively, adjusted OR 0.84, 95% CI 0.35-2.01; P = 0.70, logistic regression). Complications rates were 28% and 13% (P = 0.08, χ2 test) at colorectal site and 15% and 17% (P = 0.80, χ2 test) at liver site, in simultaneous- and delayed-resection groups, respectively. In the delayed-resection group, 8 patients did not reach the liver resection stage, and this was due to disease progression in 6 cases. After 2 years, overall and disease-free survival tended to be improved in simultaneous as compared with delayed-resection groups (P = 0.05), a tendency which persisted for OS after a median follow-up of 47 months. CONCLUSIONS: Complication rates did not appear to differ when colorectal cancer and synchronous liver metastases are resected simultaneously. Delayed resection tended to impair overall survival.
Authors: Dyre Kleive; Eline Aas; Jon-Helge Angelsen; Erling A Bringeland; Arild Nesbakken; Linn S Nymo; Johannes K Schultz; Kjetil Søreide; Sheraz Yaqub Journal: Oncol Ther Date: 2021-03-23