Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry
Autor: | Jen-Kou Lin, Francesco Ardito, Jean-Francois Ouellet, Irinel Popescu, Helena Isoniemi, Santiago López-Ben, Catherine Hubert, Luca Viganò, Alessandro Ferrero, Eduardo Barroso, Oleg G Skipenko, Agostino Maria De Rose, Darius F. Mirza, Gernot M. Kaiser, Réal Lapointe, Felice Giuliante, René Adam, Jean-Marc Regimbeau |
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Přispěvatelé: | UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Clinicum, IV kirurgian klinikka, HUS Abdominal Center |
Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
Surgical strategy Bodylift Settore MED/18 - CHIRURGIA GENERALE 3122 Cancers Medizin Simultaneous resection PROGRESSION SIMULTANEOUS RESECTION 030230 surgery Body Contouring Surgery Gastroenterology Obesity lipobody lift NEOADJUVANT CHEMOTHERAPY MORBIDITY 03 medical and health sciences CONTRAINDICATION 0302 clinical medicine Text mining Surgical oncology Internal medicine MANAGEMENT Medicine Hepatectomy Humans In patient Registries RECURRENCE RECTAL-CANCER Retrospective Studies OUTCOMES business.industry Hazard ratio Liver Neoplasms Abdominoplasty 3126 Surgery anesthesiology intensive care radiology colorectal liver metastases Oncology Liver Hepatobiliary Tumors 030220 oncology & carcinogenesis CLASSICAL STRATEGY Propensity score matching liver resection Massive weight loss Surgery Hepatic tumor business Colorectal Neoplasms |
Zdroj: | Annals of Surgical Oncology, Vol. 28, no. 13, p. 8198-8208 (2021) Annals of Surgical Oncology |
Popis: | Background The liver-first approach in patients with synchronous colorectal liver metastases (CRLM) has gained wide consensus but its role is still to be clarified. We aimed to elucidate the outcome of the liver-first approach and to identify patients who benefit at most from this approach. Methods Patients with synchronous CRLM included in the LiverMetSurvey registry between 2000 and 2017 were considered. Three strategies were analyzed, i.e. liver-first approach, colorectal resection followed by liver resection (primary-first), and simultaneous resection, and three groups of patients were analyzed, i.e. solitary metastasis, multiple unilobar CRLM, and multiple bilobar CRLM. In each group, patients from the three strategy groups were matched by propensity score analysis. Results Overall, 7360 patients were analyzed: 4415 primary-first, 552 liver-first, and 2393 simultaneous resections. Compared with the other groups, the liver-first group had more rectal tumors (58.0% vs. 31.2%) and higher hepatic tumor burden (more than three CRLMs: 34.8% vs. 24.0%; size > 50 mm: 35.6% vs. 22.8%; p < 0.001). In patients with solitary and multiple unilobar CRLM, survival was similar regardless of treatment strategy, whereas in patients with multiple bilobar metastases, the liver-first approach was an independent positive prognostic factor, both in unmatched patients (3-year survival 65.9% vs. primary-first 60.4%: hazard ratio [HR] 1.321, p = 0.031; vs. simultaneous resections 54.4%: HR 1.624, p < 0.001) and after propensity score matching (vs. primary-first: HR 1.667, p = 0.017; vs. simultaneous resections: HR 2.278, p = 0.003). Conclusion In patients with synchronous CRLM, the surgical strategy should be decided according to the hepatic tumor burden. In the presence of multiple bilobar CRLM, the liver-first approach is associated with longer survival than the alternative approaches and should be evaluated as standard. |
Databáze: | OpenAIRE |
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