Long-Term Results of Liver-First Approach Strategy in Patients with Advanced Synchronous Liver Metastases from Colorectal Cancer

Abstract

Background: The ‘‘liver-first” approach (LFA) is a strategy indicated for advanced synchronous liver metastases (ASLM) from colorectal cancer (CRC). Includes resection of the ASLM before the primary tumor after neoadjuvant chemotherapy. Methods: Retrospective descriptive analysis from a prospective database of hepatectomies from liver metastases (LM) from CRC in two centers. Between 2007-2019, from the total of hepatectomies performed (609), 88 patients with CRC-ASLM were included in a LFA scheme. Bilobar (LM) was present in 65.9%, the mean number of lesions was 5.5 and mean size 42.7mm. Response to treatment was assessed by RECIST classification. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier survival curves. Results: 75 of 88 patients (85.2%) completed the LFA. RECIST evaluation showed partial response in 75.7% and stable disease in 22.8%. Severe morbidity rate (Clavien–Dindo ≥ IIIA) after liver and colorectal surgery was present in 29.4% and 9.3%, respectively. There was no 90-day postoperative mortality in both liver and colorectal surgeries. Recurrence rate was 76%, being the liver the most frequent site, followed by the pulmonary. From the total number of recurrences (106) in 56 patients, surgical with or without chemotherapy rescue treatment was accomplished in 34 of them (32.1%). The mean PFS and OS was 8.6 and 41.2 months, respectively. Conclusions: In patients with CRC-ASLM the LFA is feasible and safe. It allows control of the liver disease beforehand and an assessment of the tumor response to neoadjuvant chemotherapy, optimizing the chance of potentially curative liver resection, which influences long-term survival.