The liver-first approach for synchronous colorectal liver metastasis: outcomes of a ten-year experience

Abstract

Background: The feasibility of the liver-first approach for synchronous colorectal cancer and colorectal liver metastases (CRLM) has been established. We sought to assess the short-term and long-term outcomes for these patients. Methods: Outcomes of patients who underwent a liver-first approach for CRLM between 2005-2015 were evaluated from a prospective database. Results: Of the 92 patients planned to undergo the liver-first strategy, most were male(n=70; 76%) and had their primary tumor located in the rectum(n=68;74%). Most patients had a T3(n=41;45%) tumor and were node positive(55%). The CRLM were bilobar in 51 patients(55%); with a median number of three lesions[1-9]. While 58 patients(63%) underwent a minor resection, 28(30%) underwent a major resection and six(7%) had irresectable disease. An additional 12 patients(13%) did not undergo resection of their primary tumor; in 71(77%) patients the paradigm was completed. Post-operative morbidity and mortality were 29%(Clavien>3=20%) and 3% following liver resection and 30%(Clavien>3=19%) and 0% after colorectal surgery, respectively. On an intention-to-treat-basis, overall 3- and 5-year survival was 54% and 35%, respectively. However, 78% of patients who completed the treatment had recurred at the last follow-up. Conclusion: The liver-first paradigm was completed in approximately three-quarter of patients. Overall survival in the present cohort was considerable, but the majority of patients did recur, stressing the importance of a tailor-made approach for this group.