Are the Short-Term Outcomes of Liver First Approach Different Depending on the Location of the Primary?

M Serradilla-Martín,J.I Miota,E Dabán-Collado,F Rotellar-Sastre,M Alkorta-Zuloaga,M.A Gomez-Bravo,S Sanchez-Cabus,B Sanchez-Perez,J.M Ramia-Angel

doi:10.1016/j.hpb.2022.05.146

M Serradilla-Martín, J.I Miota + Show 7 more

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https://doi.org/10.1016/j.hpb.2022.05.146

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Introduction: Liver first approach was initially described for asymptomatic rectal tumors with unresectable/potentially resectable synchronous liver metastases. These criteria have been expanded over the years. We present data from a Spanish study of reverse strategy. Method: Prospective observational study in Spanish hospitals from 6/1/19 to 8/31/20. Clinical Trials registry: NCT04683783. Results: A total of 40 hospitals participated. During the study period, 2,288 hepatectomies were performed in the participating centers, 1,350 for CRLM, and 153 (11.3%) by reverse strategy. The patients were divided into 2 groups, those whose primary located in the rectum (rectum group -RG- 74 patients) and those with primary in other location (other location group -OLG- 79). In the RG, 75% of the patients were men; in the OLG the distribution by sex was similar. The median number of liver metastases in the RG was lower than in OLG (3 vs 4), as well as the median size of the lesions (27 vs 33 mm). Morbidity after liver surgery was similar in both groups (26.8 -RG- vs 23.4%). Mortality was 1.3% (2 patients, one from each group). Postoperative data after primary resection are in Table 1. 82.8% of the patients of the RG received adjuvant chemotherapy, by 68.7% of the OLG patients. Overall mortality rate was similar in both groups (5.6 vs 5.1%). Conclusion: Liver first approach is routinely performed in patients with the primary tumor in other location than rectum, although it was not the initial indication, with similar rates of postoperative morbidity and mortality.Tabled 1EP01A-002OLG (N=79)RG(N=74)p valueSex (male)41 (51.9%)56 (75.7%)0.004Approach46 (58.0%)56 (75.7%)0.114Number of liver metastasis4.00 [2.00;6.00]3.00 [2.00;6.00]0.205Larger metastasis size33.0 [17.2;60.0]27.0 [20.0;40.0]0.381Morbidity after liver surgery18 (23.4%)20 (26.8%)1.000Operating time (primary)180 [150;230]220 [180;278]0.021Morbidity after primary resection17 (21.7%)25 (33.8%)0.170Reoperation rate4.41%9.23%0.318Mean stay6.00 [5.00;9.00]7.00 [5.00;11.0]0.293 Open table in a new tab

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