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
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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