Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry
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...
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| Veröffentlicht in: | Annals of surgical oncology 2021-12, Vol.28 (13), p.8198-8208 |
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| creator | Giuliante, Felice Viganò, Luca De Rose, Agostino M. Mirza, Darius F. Lapointe, Réal Kaiser, Gernot Barroso, Eduardo Ferrero, Alessandro Isoniemi, Helena Lopez-Ben, Santiago Popescu, Irinel Ouellet, Jean-Francois Hubert, Catherine Regimbeau, Jean-Marc Lin, Jen-Kou Skipenko, Oleg G. Ardito, Francesco Adam, René |
| description | 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. |
| doi_str_mv | 10.1245/s10434-021-10220-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8590998</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2597363953</sourcerecordid><originalsourceid>FETCH-LOGICAL-c508t-9776b79e1edd38f4d2124b6971bbf75754b8394a1a6040f987ce0d1d06d094783</originalsourceid><addsrcrecordid>eNp9UsFu1DAUtBAVLYUf4IAscYFDynNsxzEHpNWKUqStQBTOlpM4G1fZeLGdVPl7vE0ppQckS7ae580bjwehVwTOSM74-0CAUZZBTjICeQ7ZzRN0QngqsaIkT9MZijKTecGP0fMQrgGIoMCfoWPKcpLnnJ2gaWMn47Nz60PEq_3eO113uHUeX81D3Xk3uDHgteudN3XUPb40UYe0TPiAV4Pu52ADdi0WtAD8TUdrhhhw690Ox87gW_rUczX6ycz4u9naEP38Ah21ug_m5d1-in6ef_qxvsg2Xz9_Wa82Wc2hjJkUoqiENMQ0DS1b1iTZrCqkIFXVCi44q0oqmSa6AAatLEVtoCENFA1IJkp6ij4uvPux2pmmTuK87tXe2532s3Laqn9vBtuprZtUySVIeSB4txB0j9ouVht1qAHlknNCJpKwb--GefdrNCGqnQ216Xs9mOSiSoaXjEBSnaBvHkGv3eiTnQeUTF5SyWlC5Quq9i4Eb9p7BQTUIQJqiYBKEVC3EVA3qen1wyfft_z58wSgCyCkq2Fr_N_Z_6H9De3UvL0</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2597363953</pqid></control><display><type>article</type><title>Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Giuliante, Felice ; Viganò, Luca ; De Rose, Agostino M. ; Mirza, Darius F. ; Lapointe, Réal ; Kaiser, Gernot ; Barroso, Eduardo ; Ferrero, Alessandro ; Isoniemi, Helena ; Lopez-Ben, Santiago ; Popescu, Irinel ; Ouellet, Jean-Francois ; Hubert, Catherine ; Regimbeau, Jean-Marc ; Lin, Jen-Kou ; Skipenko, Oleg G. ; Ardito, Francesco ; Adam, René</creator><creatorcontrib>Giuliante, Felice ; Viganò, Luca ; De Rose, Agostino M. ; Mirza, Darius F. ; Lapointe, Réal ; Kaiser, Gernot ; Barroso, Eduardo ; Ferrero, Alessandro ; Isoniemi, Helena ; Lopez-Ben, Santiago ; Popescu, Irinel ; Ouellet, Jean-Francois ; Hubert, Catherine ; Regimbeau, Jean-Marc ; Lin, Jen-Kou ; Skipenko, Oleg G. ; Ardito, Francesco ; Adam, René</creatorcontrib><description>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.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-021-10220-w</identifier><identifier>PMID: 34212254</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Colorectal Neoplasms - surgery ; Hepatectomy ; Hepatobiliary Tumors ; Humans ; Life Sciences ; Liver ; Liver Neoplasms - surgery ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Oncology ; Patients ; Registries ; Retrospective Studies ; Surgery ; Surgical Oncology ; Survival ; Tumors</subject><ispartof>Annals of surgical oncology, 2021-12, Vol.28 (13), p.8198-8208</ispartof><rights>The Author(s) 2021</rights><rights>2021. The Author(s).</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-9776b79e1edd38f4d2124b6971bbf75754b8394a1a6040f987ce0d1d06d094783</citedby><cites>FETCH-LOGICAL-c508t-9776b79e1edd38f4d2124b6971bbf75754b8394a1a6040f987ce0d1d06d094783</cites><orcidid>0000-0001-7631-9112 ; 0000-0001-9908-8265</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-021-10220-w$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-021-10220-w$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34212254$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://u-picardie.hal.science/hal-03595511$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Giuliante, Felice</creatorcontrib><creatorcontrib>Viganò, Luca</creatorcontrib><creatorcontrib>De Rose, Agostino M.</creatorcontrib><creatorcontrib>Mirza, Darius F.</creatorcontrib><creatorcontrib>Lapointe, Réal</creatorcontrib><creatorcontrib>Kaiser, Gernot</creatorcontrib><creatorcontrib>Barroso, Eduardo</creatorcontrib><creatorcontrib>Ferrero, Alessandro</creatorcontrib><creatorcontrib>Isoniemi, Helena</creatorcontrib><creatorcontrib>Lopez-Ben, Santiago</creatorcontrib><creatorcontrib>Popescu, Irinel</creatorcontrib><creatorcontrib>Ouellet, Jean-Francois</creatorcontrib><creatorcontrib>Hubert, Catherine</creatorcontrib><creatorcontrib>Regimbeau, Jean-Marc</creatorcontrib><creatorcontrib>Lin, Jen-Kou</creatorcontrib><creatorcontrib>Skipenko, Oleg G.</creatorcontrib><creatorcontrib>Ardito, Francesco</creatorcontrib><creatorcontrib>Adam, René</creatorcontrib><title>Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>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.</description><subject>Colorectal Neoplasms - surgery</subject><subject>Hepatectomy</subject><subject>Hepatobiliary Tumors</subject><subject>Humans</subject><subject>Life Sciences</subject><subject>Liver</subject><subject>Liver Neoplasms - surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Oncology</subject><subject>Patients</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival</subject><subject>Tumors</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9UsFu1DAUtBAVLYUf4IAscYFDynNsxzEHpNWKUqStQBTOlpM4G1fZeLGdVPl7vE0ppQckS7ae580bjwehVwTOSM74-0CAUZZBTjICeQ7ZzRN0QngqsaIkT9MZijKTecGP0fMQrgGIoMCfoWPKcpLnnJ2gaWMn47Nz60PEq_3eO113uHUeX81D3Xk3uDHgteudN3XUPb40UYe0TPiAV4Pu52ADdi0WtAD8TUdrhhhw690Ox87gW_rUczX6ycz4u9naEP38Ah21ug_m5d1-in6ef_qxvsg2Xz9_Wa82Wc2hjJkUoqiENMQ0DS1b1iTZrCqkIFXVCi44q0oqmSa6AAatLEVtoCENFA1IJkp6ij4uvPux2pmmTuK87tXe2532s3Laqn9vBtuprZtUySVIeSB4txB0j9ouVht1qAHlknNCJpKwb--GefdrNCGqnQ216Xs9mOSiSoaXjEBSnaBvHkGv3eiTnQeUTF5SyWlC5Quq9i4Eb9p7BQTUIQJqiYBKEVC3EVA3qen1wyfft_z58wSgCyCkq2Fr_N_Z_6H9De3UvL0</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Giuliante, Felice</creator><creator>Viganò, Luca</creator><creator>De Rose, Agostino M.</creator><creator>Mirza, Darius F.</creator><creator>Lapointe, Réal</creator><creator>Kaiser, Gernot</creator><creator>Barroso, Eduardo</creator><creator>Ferrero, Alessandro</creator><creator>Isoniemi, Helena</creator><creator>Lopez-Ben, Santiago</creator><creator>Popescu, Irinel</creator><creator>Ouellet, Jean-Francois</creator><creator>Hubert, Catherine</creator><creator>Regimbeau, Jean-Marc</creator><creator>Lin, Jen-Kou</creator><creator>Skipenko, Oleg G.</creator><creator>Ardito, Francesco</creator><creator>Adam, René</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><general>Springer Verlag</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>1XC</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7631-9112</orcidid><orcidid>https://orcid.org/0000-0001-9908-8265</orcidid></search><sort><creationdate>20211201</creationdate><title>Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry</title><author>Giuliante, Felice ; Viganò, Luca ; De Rose, Agostino M. ; Mirza, Darius F. ; Lapointe, Réal ; Kaiser, Gernot ; Barroso, Eduardo ; Ferrero, Alessandro ; Isoniemi, Helena ; Lopez-Ben, Santiago ; Popescu, Irinel ; Ouellet, Jean-Francois ; Hubert, Catherine ; Regimbeau, Jean-Marc ; Lin, Jen-Kou ; Skipenko, Oleg G. ; Ardito, Francesco ; Adam, René</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c508t-9776b79e1edd38f4d2124b6971bbf75754b8394a1a6040f987ce0d1d06d094783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Colorectal Neoplasms - surgery</topic><topic>Hepatectomy</topic><topic>Hepatobiliary Tumors</topic><topic>Humans</topic><topic>Life Sciences</topic><topic>Liver</topic><topic>Liver Neoplasms - surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Oncology</topic><topic>Patients</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Giuliante, Felice</creatorcontrib><creatorcontrib>Viganò, Luca</creatorcontrib><creatorcontrib>De Rose, Agostino M.</creatorcontrib><creatorcontrib>Mirza, Darius F.</creatorcontrib><creatorcontrib>Lapointe, Réal</creatorcontrib><creatorcontrib>Kaiser, Gernot</creatorcontrib><creatorcontrib>Barroso, Eduardo</creatorcontrib><creatorcontrib>Ferrero, Alessandro</creatorcontrib><creatorcontrib>Isoniemi, Helena</creatorcontrib><creatorcontrib>Lopez-Ben, Santiago</creatorcontrib><creatorcontrib>Popescu, Irinel</creatorcontrib><creatorcontrib>Ouellet, Jean-Francois</creatorcontrib><creatorcontrib>Hubert, Catherine</creatorcontrib><creatorcontrib>Regimbeau, Jean-Marc</creatorcontrib><creatorcontrib>Lin, Jen-Kou</creatorcontrib><creatorcontrib>Skipenko, Oleg G.</creatorcontrib><creatorcontrib>Ardito, Francesco</creatorcontrib><creatorcontrib>Adam, René</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Giuliante, Felice</au><au>Viganò, Luca</au><au>De Rose, Agostino M.</au><au>Mirza, Darius F.</au><au>Lapointe, Réal</au><au>Kaiser, Gernot</au><au>Barroso, Eduardo</au><au>Ferrero, Alessandro</au><au>Isoniemi, Helena</au><au>Lopez-Ben, Santiago</au><au>Popescu, Irinel</au><au>Ouellet, Jean-Francois</au><au>Hubert, Catherine</au><au>Regimbeau, Jean-Marc</au><au>Lin, Jen-Kou</au><au>Skipenko, Oleg G.</au><au>Ardito, Francesco</au><au>Adam, René</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2021-12-01</date><risdate>2021</risdate><volume>28</volume><issue>13</issue><spage>8198</spage><epage>8208</epage><pages>8198-8208</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>34212254</pmid><doi>10.1245/s10434-021-10220-w</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-7631-9112</orcidid><orcidid>https://orcid.org/0000-0001-9908-8265</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Annals of surgical oncology, 2021-12, Vol.28 (13), p.8198-8208 |
| issn | 1068-9265 1534-4681 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Colorectal Neoplasms - surgery Hepatectomy Hepatobiliary Tumors Humans Life Sciences Liver Liver Neoplasms - surgery Medicine Medicine & Public Health Metastases Metastasis Oncology Patients Registries Retrospective Studies Surgery Surgical Oncology Survival Tumors |
| title | Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry |
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