Trends in multimodal treatment and long-term outcomes of patients with resected colorectal liver metastases in a Brazilian Cancer Center

Abstract

Introduction: Advances in systemic treatment and perioperative care improved the results of surgical treatment of colorectal liver metastases around the world. The aim of this study was to analyze the evolution of multimodal and surgical treatments of colorectal liver metastases in a Brazilian referral cancer center. Methods: A retrospective analyzes of medical records from patients with colorectal liver metastases who underwent curative liver resections from 1998 to 2012 was performed. The study period was divided in tree 5-year intervals. Multimodal treatment strategies, surgical morbimortality and survival outcomes were analyzed through time. Results: In the study period, 346 liver resections were performed in 285 patients. An increasing number of rectal primaries tumors were observed, without difference in lymph node metastases. Through these intervals, synchronous, multinodular and bilobar metastases become more frequent. Probably due to these factors, the use of multimodal treatment, mostly perioperative chemotherapy increased along time, reaching 72% of patients in the last 5-year period. Regarding surgical procedures, the proportion of major hepatectomies and simultaneous liver and primary resections increased, without significant increment in operative time, blood transfusion rate, morbidity and mortality. Both overall and disease free survivals were similar in the three groups (Table 1).Table1998 to 20022003 to 20072008 to 2012pMultimodal treatment66.6%89.7%94.0%<0.001Preoperative chemotherapy21.4%46.5%72.0%<0.001Major liver resections64.2%50.0%66.0%0.047Primary simultaneous resection04.5%11.2%0.045Blood transfusion37.0%34.0%31.3%0.800Postoperative complications53.5%53.4%65.6%0.116Mortality03.4%5.3%0.6175 year OS48.1%72.8%76.0%0.1265 year DFS38.5%28.9%24.2%0.503[Comparison between periods] Open table in a new tab [Comparison between periods] Conclusion: Our cohort showed that multimodal treatment has been more frequently used and similar surgical and survival outcomes could be observed even with the increasing number of patients with non-favorable prognostic factors through this 15-year period.