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Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry
BACKGROUND: The liver-first approach in patients with synchronous colorectal liver metastases (CRLM) has gained wide consensus but its role is still to be clarified. We aimed to elucidate the outcome of the liver-first approach and to identify patients who benefit at most from this approach. METHODS...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590998/ https://www.ncbi.nlm.nih.gov/pubmed/34212254 http://dx.doi.org/10.1245/s10434-021-10220-w |
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author | Giuliante, Felice Viganò, Luca De Rose, Agostino M. Mirza, Darius F. Lapointe, Réal Kaiser, Gernot Barroso, Eduardo Ferrero, Alessandro Isoniemi, Helena Lopez-Ben, Santiago Popescu, Irinel Ouellet, Jean-Francois Hubert, Catherine Regimbeau, Jean-Marc Lin, Jen-Kou Skipenko, Oleg G. Ardito, Francesco Adam, René |
author_facet | Giuliante, Felice Viganò, Luca De Rose, Agostino M. Mirza, Darius F. Lapointe, Réal Kaiser, Gernot Barroso, Eduardo Ferrero, Alessandro Isoniemi, Helena Lopez-Ben, Santiago Popescu, Irinel Ouellet, Jean-Francois Hubert, Catherine Regimbeau, Jean-Marc Lin, Jen-Kou Skipenko, Oleg G. Ardito, Francesco Adam, René |
author_sort | Giuliante, Felice |
collection | PubMed |
description | BACKGROUND: The liver-first approach in patients with synchronous colorectal liver metastases (CRLM) has gained wide consensus but its role is still to be clarified. We aimed to elucidate the outcome of the liver-first approach and to identify patients who benefit at most from this approach. METHODS: Patients with synchronous CRLM included in the LiverMetSurvey registry between 2000 and 2017 were considered. Three strategies were analyzed, i.e. liver-first approach, colorectal resection followed by liver resection (primary-first), and simultaneous resection, and three groups of patients were analyzed, i.e. solitary metastasis, multiple unilobar CRLM, and multiple bilobar CRLM. In each group, patients from the three strategy groups were matched by propensity score analysis. RESULTS: Overall, 7360 patients were analyzed: 4415 primary-first, 552 liver-first, and 2393 simultaneous resections. Compared with the other groups, the liver-first group had more rectal tumors (58.0% vs. 31.2%) and higher hepatic tumor burden (more than three CRLMs: 34.8% vs. 24.0%; size > 50 mm: 35.6% vs. 22.8%; p < 0.001). In patients with solitary and multiple unilobar CRLM, survival was similar regardless of treatment strategy, whereas in patients with multiple bilobar metastases, the liver-first approach was an independent positive prognostic factor, both in unmatched patients (3-year survival 65.9% vs. primary-first 60.4%: hazard ratio [HR] 1.321, p = 0.031; vs. simultaneous resections 54.4%: HR 1.624, p < 0.001) and after propensity score matching (vs. primary-first: HR 1.667, p = 0.017; vs. simultaneous resections: HR 2.278, p = 0.003). CONCLUSION: In patients with synchronous CRLM, the surgical strategy should be decided according to the hepatic tumor burden. In the presence of multiple bilobar CRLM, the liver-first approach is associated with longer survival than the alternative approaches and should be evaluated as standard. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-021-10220-w. |
format | Online Article Text |
id | pubmed-8590998 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-85909982021-11-23 Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry Giuliante, Felice Viganò, Luca De Rose, Agostino M. Mirza, Darius F. Lapointe, Réal Kaiser, Gernot Barroso, Eduardo Ferrero, Alessandro Isoniemi, Helena Lopez-Ben, Santiago Popescu, Irinel Ouellet, Jean-Francois Hubert, Catherine Regimbeau, Jean-Marc Lin, Jen-Kou Skipenko, Oleg G. Ardito, Francesco Adam, René Ann Surg Oncol Hepatobiliary Tumors BACKGROUND: The liver-first approach in patients with synchronous colorectal liver metastases (CRLM) has gained wide consensus but its role is still to be clarified. We aimed to elucidate the outcome of the liver-first approach and to identify patients who benefit at most from this approach. METHODS: Patients with synchronous CRLM included in the LiverMetSurvey registry between 2000 and 2017 were considered. Three strategies were analyzed, i.e. liver-first approach, colorectal resection followed by liver resection (primary-first), and simultaneous resection, and three groups of patients were analyzed, i.e. solitary metastasis, multiple unilobar CRLM, and multiple bilobar CRLM. In each group, patients from the three strategy groups were matched by propensity score analysis. RESULTS: Overall, 7360 patients were analyzed: 4415 primary-first, 552 liver-first, and 2393 simultaneous resections. Compared with the other groups, the liver-first group had more rectal tumors (58.0% vs. 31.2%) and higher hepatic tumor burden (more than three CRLMs: 34.8% vs. 24.0%; size > 50 mm: 35.6% vs. 22.8%; p < 0.001). In patients with solitary and multiple unilobar CRLM, survival was similar regardless of treatment strategy, whereas in patients with multiple bilobar metastases, the liver-first approach was an independent positive prognostic factor, both in unmatched patients (3-year survival 65.9% vs. primary-first 60.4%: hazard ratio [HR] 1.321, p = 0.031; vs. simultaneous resections 54.4%: HR 1.624, p < 0.001) and after propensity score matching (vs. primary-first: HR 1.667, p = 0.017; vs. simultaneous resections: HR 2.278, p = 0.003). CONCLUSION: In patients with synchronous CRLM, the surgical strategy should be decided according to the hepatic tumor burden. In the presence of multiple bilobar CRLM, the liver-first approach is associated with longer survival than the alternative approaches and should be evaluated as standard. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-021-10220-w. Springer International Publishing 2021-07-01 2021 /pmc/articles/PMC8590998/ /pubmed/34212254 http://dx.doi.org/10.1245/s10434-021-10220-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Hepatobiliary Tumors Giuliante, Felice Viganò, Luca De Rose, Agostino M. Mirza, Darius F. Lapointe, Réal Kaiser, Gernot Barroso, Eduardo Ferrero, Alessandro Isoniemi, Helena Lopez-Ben, Santiago Popescu, Irinel Ouellet, Jean-Francois Hubert, Catherine Regimbeau, Jean-Marc Lin, Jen-Kou Skipenko, Oleg G. Ardito, Francesco Adam, René Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry |
title | Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry |
title_full | Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry |
title_fullStr | Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry |
title_full_unstemmed | Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry |
title_short | Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry |
title_sort | liver-first approach for synchronous colorectal metastases: analysis of 7360 patients from the livermetsurvey registry |
topic | Hepatobiliary Tumors |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590998/ https://www.ncbi.nlm.nih.gov/pubmed/34212254 http://dx.doi.org/10.1245/s10434-021-10220-w |
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