Synchronous colorectal liver metastasis managment: A single-cente analysis

Abstract

Introduction: The optimal management of colorectal cancer (CRC) with synchronous liver metastases need reach clarity. Two different sites with tumor give rise to different approach. The literature show us three approach: classical approach (CA), simultaneous approach (SA) and liver-first approach (LFA) but the data are contradictory. We analysed our synchronous liver metastases in CRC Material and methods: We analyzed 168 synchronous liver metastases resected restrospectively in our data base from January 2004 to January 2014. Synchronous' definition was when the liver metastases were diagnosed preoperatively or in the first surgery of CRC. We compared the three groups. 74 variables were collected. Results: 59.5% were CA (CCR first) 29.2% SA and 11.3% LFA. 1, 3 and, 5 years OS rate were: CA 92.6%, 62.1% and 51.7%, SA 92.7%, 63.2% and, 31.6% and, LFA 92.3%, 61.5% and 25% respectively. DSF rate 1,3 and 5 years were: CA 72.2%, 36.6% and 29.8%, SA 66.1%, 45.1% and 22.5% and, LFA 50, 30 and. 20%. There were not differences among three approach in DSF but in OS: CA vs SA (51.7% vs 31.6%, p = 0.014) and CA vs LFA (51.7% vs 25%, p = 0.038), no differences SA vs LFA (31.6% vs 25%, p = 0.371). In the SA there were more minor hepatectomies. There were not morbidity difference but LFA had highest mortality. Patients with LFA had more neoadjuvant therapy, major hepatectomies, T-rectal localization and, R1 vs CA and SA. Conclusions: Although our data show no demographic, DFS and morbidity rate differences, we think three procedures should have a different role.