Simultaneous or staged resection of synchronous colorectal cancer liver metastases: a 13-year institutional follow-up

Larsson, Anna; Björnsson, Bergþór; Jung, B.; Hallböök, Olof; Vernmark, Karolina; Berg, Katarina; Sandström, Per

doi:10.1016/j.hpb.2021.11.019

Cited by 7 publications

(5 citation statements)

References 43 publications

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“…Our study demonstrated that OS and DFS were similar for both therapeutic approaches, which is in line with what is described in the literature. (2,4,7,16,20,21) This similarity was maintained for one-and three-year survival, as observed in the study by Slesser et al (21) The same was verified when the hepatic tumor burden was considered, in which no statistically significant difference was observed in the OS and DFS according to the hepatic tumor burden, contrary to what is described in the literature. (3,4) However, it should be noted that the choice of therapeutic approach was assessed by a multidisciplinary team, individualized and carried out according to the hepatic tumor burden of each patient, so we believe that the lack of statistical results is due to a correct pre-selection of patients for each approach.…”

Section: Discussionsupporting

confidence: 71%

Approach to synchronous liver metastases from colorectal carcinoma - results from a Portuguese reference center

Ruivo,

Monteiro,

Paiva

et al. 2023

Braz. J. Hea. Rev.

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About 15%-25% of patients with colorectal cancer, have synchronous liver metastases. The best surgical approach for the patients with asymptomatic primary colorectal tumor and synchronous liver metastases is still the subject of much debate. We aimed to evaluate the perioperative and long-term results as well as to identify possible prognostic factors of the two strategies: liver- first and synchronous resection. Observational, retrospective study, which included patients with synchronous liver metastases from colorectal cancer, who underwent liver surgery between January 2016 and December 2021, in a Portuguese reference center. Patients were divided into two groups according to the therapeutic approach (synchronous resections vs Liver First) and into three groups according to the hepatic tumor burden (single liver lesion versus more than three liver lesions versus bilobar lesions). To determine the overall and disease-free survival, Kaplan-Meier curves and the log-rank test were performed and, to identify factors with an impact on the prognosis, a univariate and multivariate analysis were performed with the application of Cox regression (significance of 5%). Among the 46 patients included, 54,4% underwent the liver-first approach and 21 patients (45.7%) underwent simultaneous resection. The liver-first group had a greater number of patients with primary rectal tumor (84% vs.14.3%; p<0.001), with more than 3 hepatic lesions (56% vs.14%; p=0.004) and with more extensive hepatic resection. As for postoperative morbimortality, no statistically significant difference was observed between the two approaches (p=0.514). The median overall survival was similar even when considering the hepatic tumor burden (35.0 months (95%CI 15.91- 54.09) in the liver-first group vs. 48.0 months (95%CI 21.69-74.96) in the synchronous resection group; p=0.145). The same was observed for the median disease-free survival (16.0 months (95% CI 0-32.7) vs. 23.0 months (95% CI 16.3-29.7) p=0.651, respectively). The two strategies showed similar morbidity. No statistically significant difference was observed with regard to overall and disease-free survival even when the hepatic tumor burden was considered. One-year and three-year survival were also similar. However, it should be stressed that, the choice of the surgical approach for each group did not took into account the hepatic tumor burden, which we believe it is essential in choosing the best surgical approach.The existence of a multidisciplinary team is fundamental for the therapeutic success of these patients.

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Section: Discussionsupporting

confidence: 71%

Approach to synchronous liver metastases from colorectal carcinoma - results from a Portuguese reference center

Ruivo,

Monteiro,

Paiva

et al. 2023

Braz. J. Hea. Rev.

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“…Two recent institutional studies have investigated the impact of simultaneous resections on long term oncological outcomes. Larsson et al 13 used a propensity matching of patients who underwent a staged versus simultaneous resection approach. This study found that after matching, patients who underwent simultaneous resections had shorter LOS (11 vs. 16 days), fewer cancer recurrences, and no differences in disease‐free survival or overall survival compared to those who underwent staged resections.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous resection of colorectal cancer and synchronous colorectal liver metastases: A risk stratified analysis of the NSQIP database

Radomski

Chen

Stem

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesOver 25% of patients diagnosed with colorectal cancer (CRC) will develop colorectal liver metastases (CRLM). Controversy exists over the surgical management of these patients. This study aims to investigate the safety of a simultaneous surgical approach by stratifying patients based on procedure risk and operative approach.MethodsUsing ACS‐NSQIP (2016–2020), patients with CRC who underwent isolated colorectal, isolated hepatic, or simultaneous resections were identified. Colorectal and hepatic procedures were stratified by morbidity risk (high vs. low) and operative approach (open vs. minimally invasive). Thirty‐day overall morbidity was compared between risk matched isolated and simultaneous resection groups.ResultsA total of 65 417 patients were identified, with 1550 (2.4%) undergoing simultaneous resections. A total of 1207 (77.9%) underwent a low‐risk colorectal and low‐risk liver resection. On multivariate analysis, there was no significant difference in overall morbidity between patients who had a simultaneous open high‐risk colorectal/low‐risk hepatic procedure compared to patients who had an isolated open high‐risk colorectal procedure (odds ratio: 1.19; 95% confidence interval: 0.94–1.50; p = 0.148). All other combinations of simultaneous procedures had statistically significant higher rates of morbidity than the isolated group.ConclusionsSimultaneous resection of colorectal and synchronous CRLM is associated with an increased risk of morbidity in most circumstances in a risk stratified analysis, although rates of readmission and reoperation were not increased. Minimally invasive surgical approaches may significantly mitigate this morbidity.

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“…Synchronous CRLM have long been assumed to represent a more aggressive spectrum of disease but there is no firm evidence to support this. Although it remains usual to deal with the primary tumor first, several studies have demonstrated equivalent survival rates and reduced hospital stays for patients undergoing synchronous resection of both primary and CRLM compared to staged resection 83–86 . It is clear, once again, that patient selection is paramount.…”

Section: Synchronous Diseasementioning

confidence: 99%

“…Although it remains usual to deal with the primary tumor first, several studies have demonstrated equivalent survival rates and reduced hospital stays for patients undergoing synchronous resection of both primary and CRLM compared to staged resection. 83 , 84 , 85 , 86 It is clear, once again, that patient selection is paramount. Combining the first stage of two‐stage liver surgery with resection of the primary tumor is clearly another option.…”

Section: Synchronous Diseasementioning

confidence: 99%

New trends in surgery for colorectal liver metastasis

Kron,

Lodge

2024

Annals of Gastroent Surgery

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By presenting the most up‐to‐date findings and incorporating the latest evidence, this article seeks to present a comprehensive guide for navigating the complexities inherent in the management of colorectal liver metastasis. It aims to serve as a valuable resource offering clinicians and healthcare professionals an understanding of the diverse modalities and approaches available for treating this challenging and multifaceted disease. In an era of rapidly evolving medical knowledge, this article examines the latest insights to make informed decisions in the realm of colorectal liver metastasis management. The article does not only highlight the up‐to‐date knowledge but also provides the evidence for existing therapeutic strategies. This practical tool provides evidence‐based recommendations to clinicians, thereby contributing to the ongoing advancement of effective treatment strategies for this challenging disease.

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Simultaneous or staged resection of synchronous colorectal cancer liver metastases: a 13-year institutional follow-up

Cited by 7 publications

References 43 publications

Approach to synchronous liver metastases from colorectal carcinoma - results from a Portuguese reference center

Approach to synchronous liver metastases from colorectal carcinoma - results from a Portuguese reference center

Simultaneous resection of colorectal cancer and synchronous colorectal liver metastases: A risk stratified analysis of the NSQIP database

New trends in surgery for colorectal liver metastasis

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