Colorectal cancer liver metastases (crlm) resection: Multidisciplinary specialized care increases 5-year conditional survival

Abstract

Presenter: Jaime Kruger MD | Hospital das Clinicas - University of Sao Paulo Background: Half of patients bearing colorectal tumors are expected to develop liver metastases at some point of their disease. Liver resection is considered the best treatment in order to achieve long-term survival and, sometimes, cure. Along the past two decades 5-year survival has increased after liver resection, mostly due to improved surgical and oncological care. Our institution incorporated a dedicated cancer center during it`s experience on the management of CRLM and witnessed the impact of multidisciplinary specialized care on the survival of patients operated for CRLM. Beyond cumulative survival curves, conditional survival is an interesting tool as it describes expected survival during follow-up, a forward-looking information. We sought to evaluate overall and five-year conditional survival of consecutive patients operated for the treatment of CRLM at the Liver Surgery Unit – Hospital das Clinicas – University of Sao Paulo after the institution of a specialized multidisciplinary cancer center. Methods: Retrospective analysis comparing two institutional periods in the management of CRLM. Consecutive patients undergoing liver resection with curative intent and histologically confirmed diagnosis of MHCR, between January 2000 and December 2015 (follow up until December 2018). ERA 1 corresponded to the initial experience (January 2000 through February 2009) and ERA 2 (March 2009 to December 2015) corresponded to the period after the adoption of specialized oncologic multidisciplinary care. Demographic profile, oncological data, operative outcomes and survival analysis were performed, including 5-year conditional survival. Results: 383 patients were submitted to 402 hepatectomies, 98 patients were operated during ERA 1 and 285 during ERA 2. During ERA 1 patients presented higher levels of CEA (177.0 ng/dL vs. 70.3 ng/dL p<0.001), greater mean size of the largest resected tumor (47.5 mm vs. 33.9 mm p<0.001). In ERA 2 there were more synchronous (70.0% vs. 58.5% p=0.041), bilobar (22.3% vs. 34.8% p=0.025) and multinodular CRLM (22.8% vs. 11.5% p=0.031). During ERA2 exposure to preoperative chemotherapy was more frequent (77.3% vs. 34.1% p<0.001), predominantly oxaliplatin based. Operative results indicated that ERA 2 employed mostly minor (65.9% vs. 42.6% p<0.001) and non-anatomical resections (40.7% vs.12.8% p<0.001). Operative complications (ERA 1 32.3% vs. ERA 2 36.3% p=0.481) and overall mortality were similar between studied periods. Surgical margins did not vary significantly between ERAS. Median follow up was 42.0 months for the whole cohort (ERA1 35.5 months; ERA2 43.0 months). Overall survival in 5 years was 34.5% for ERA 1 and 48.0% for ERA 2 (p=0.011). During follow up years 1 to 5, 5-year conditional survival varied from 35.0% to 62.0% in ERA 1 and from 45.9% to 63.6% in ERA 2. being greater in every follow up year in ERA 2. Conclusion: The changes along time in the multidisciplinary specialized care to CRLM resulted in increased overall and conditional survival in ERA 2.