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CC BY 4.0 · Journal of Coloproctology 2024; 44(02): e98-e105
DOI: 10.1055/s-0044-1787073
Original Article

Clinical Outcomes of the Liver-First Approach in the Management of Synchronous Colorectal Liver Metastases: A Retrospective Study

Emad M. Abdelrahman 
1   Department of General Surgery, Faculty of Medicine, Benha University, Benha, Egypt
,
Ahmed M.F. Salama
1   Department of General Surgery, Faculty of Medicine, Benha University, Benha, Egypt
,
Amira K. ElAlfy
2   Department of Internal Medicine, Faculty of Medicine, Benha University, Benha, Egypt
,
Mohammed A. Fadey
1   Department of General Surgery, Faculty of Medicine, Benha University, Benha, Egypt
,
Mahmoud A. Negm
3   Department of Hepatology, Gastroenterology, and Infectious Diseases, Faculty of Medicine, Benha University, Benha, Egypt
,
Ahmed S. El-gazar
3   Department of Hepatology, Gastroenterology, and Infectious Diseases, Faculty of Medicine, Benha University, Benha, Egypt
,
Osama R. Abdelraouf
4   Physical Therapy Program, Batterjee Medical College, Jeddah Saudi Arabia
,
Mohamed K. Abdelaal
1   Department of General Surgery, Faculty of Medicine, Benha University, Benha, Egypt
› Institutsangaben
Funding The authors did not receive funding from agencies in the public, private, or non-profit sectors for the conduction of the present study.
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Abstract

Introduction Almost 25% of colorectal cancer (CRC) patients have synchronous colorectal liver metastasis (SCLM) coinciding with the disease diagnosis. Liver-first approach for the treatment of SCLM involves neoadjuvant chemotherapy, subsequent liver resection, and then primary tumor resection. This strategy is adopted as the prognosis of the disease depends mainly on the metastases, not the primary tumor.

This study aims to evaluate the feasibility of the liver-first approach and clinical prognosis in managing SCLM.

Materials and Methods This retrospective study included 25 patients with SCLM from July 2015 to July 2020. All patients were subjected to a liver-first approach with an “intention-to-treat” approach. Follow-up was planned for at least 3 years. Data were collected from the hospital records and included survival rates and univariate analyses of the prognostic factors, such as gender, age, and number of chemotherapy cycles to evaluate their effect on the survival probability.

Results Nineteen patients completed the treatment paradigm. Long-term outcomes reported a median overall survival (OS) of 32 months. One-year and 3-year survival probabilities were 89.5% and 42.1%, respectively. The median disease-free survival was 13 months. The number of metastatic lesions, unilobar versus bilobar disease, and the frequency of administered chemotherapy cycles significantly affected survival (p < 0.05). Seven patients (36.84%) remained disease free (no recurrence) while 2 patients (10.53%) survived with recurrence. The overall mortality included 10 deaths (52.63%) due to recurrence.

Conclusion Synchronous colorectal liver metastasis treated with the liver-first approach achieved a notable overall advantage. However, the recurrence rate remained relatively high.

Keywords

colorectal cancer - synchronous colorectal liver metastasis (SCLM)‎ - liver-first approach

Availability of Data and Materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.




Publikationsverlauf

Eingereicht: 21. Januar 2024

Angenommen: 09. April 2024

Artikel online veröffentlicht:
06. Juni 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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