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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
› Author Affiliations 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.




Publication History

Received: 21 January 2024

Accepted: 09 April 2024

Article published online:
06 June 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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  • References

  • 1 Ferlay J, Colombet M, Soerjomataram I. et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer 2019; 144 (08) 1941-1953 DOI: 10.1002/ijc.31937.
    CrossrefPubMedGoogle Scholar
  • 2 Ivey GD, Johnston FM, Azad NS, Christenson ES, Lafaro KJ, Shubert CR. Current Surgical Management Strategies for Colorectal Cancer Liver Metastases. Cancers (Basel) 2022; 14 (04) 1063 DOI: 10.3390/cancers14041063.
    CrossrefPubMedGoogle Scholar
  • 3 Hasselgren K, Røsok BI, Larsen PN. et al. ALPPS Improves Survival Compared With TSH in Patients Affected of CRLM: Survival Analysis From the Randomized Controlled Trial LIGRO. Ann Surg 2021; 273 (03) 442-448 [CrossRef] [PubMed]
    CrossrefPubMedGoogle Scholar
  • 4 Dueland S, Yaqub S, Syversveen T. et al. Survival Outcomes After Portal Vein Embolization and Liver Resection Compared With Liver Transplant for Patients With Extensive Colorectal Cancer Liver Metastases. JAMA Surg 2021; 156 (06) 550-557 [CrossRef]
    CrossrefPubMedGoogle Scholar
  • 5 Helling TS, Martin M. Cause of death from liver metastases in colorectal cancer. Ann Surg Oncol 2014; 21 (02) 501-506 [CrossRef]
    CrossrefPubMedGoogle Scholar
  • 6 Creasy JM, Sadot E, Koerkamp BG. et al. Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure?. Surgery 2018; 163 (06) 1238-1244 [CrossRef] [PubMed]
    CrossrefPubMedGoogle Scholar
  • 7 Choti MA, Thomas M, Wong SL. et al. Surgical Resection Preferences and Perceptions among Medical Oncologists Treating Liver Metastases from Colorectal Cancer. Ann Surg Oncol 2016; 23 (02) 375-381 [CrossRef] [PubMed]
    CrossrefPubMedGoogle Scholar
  • 8 Giuliante F, Viganò L, De Rose AM. et al. Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry. Ann Surg Oncol 2021; 28 (13) 8198-8208 [CrossRef] [PubMed]
    CrossrefPubMedGoogle Scholar
  • 9 Brouquet A, Mortenson MM, Vauthey JN. et al. Surgical strategies for synchronous colorectal liver metastases in 156 consecutive patients: classic, combined or reverse strategy?. J Am Coll Surg 2010; 210 (06) 934-941 [CrossRef] [PubMed]
    CrossrefPubMedGoogle Scholar
  • 10 Hellingman T, de Swart ME, Joosten JJA. et al. The value of a dedicated multidisciplinary expert panel to assess treatment strategy in patients suffering from colorectal cancer liver metastases. Surg Oncol 2020; 35: 412-417 [CrossRef] [PubMed]
    CrossrefPubMedGoogle Scholar
  • 11 de Jong MC, Beckers RCJ, van Woerden V. et al. The liver-first approach for synchronous colorectal liver metastases: more than a decade of experience in a single centre. HPB (Oxford) 2018; 20 (07) 631-640 [CrossRef]
    CrossrefPubMedGoogle Scholar
  • 12 Mentha G, Majno PE, Andres A, Rubbia-Brandt L, Morel P, Roth AD. Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg 2006; 93 (07) 872-878 [CrossRef]
    CrossrefPubMedGoogle Scholar
  • 13 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (02) 205-213
    CrossrefPubMedGoogle Scholar
  • 14 Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230 (03) 309-318 , discussion 318–321
    CrossrefPubMedGoogle Scholar
  • 15 Eisenhauer EA, Therasse P, Bogaerts J. et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45 (02) 228-247
    CrossrefPubMedGoogle Scholar
  • 16 Riddiough GE, Fifis T, Muralidharan V, Perini MV, Christophi C. Searching for the link; mechanisms underlying liver regeneration and recurrence of colorectal liver metastasis post partial hepatectomy. J Gastroenterol Hepatol 2019; 34 (08) 1276-1286
    CrossrefPubMedGoogle Scholar
  • 17 Verhoef C, van der Pool AE, Nuyttens JJ, Planting AS, Eggermont AM, de Wilt JH. The “liver-first approach” for patients with locally advanced rectal cancer and synchronous liver metastases. Dis Colon Rectum 2009; 52 (01) 23-30
    CrossrefPubMedGoogle Scholar
  • 18 de Jong MC, van Dam RM, Maas M. et al. The liver-first approach for synchronous colorectal liver metastasis: a 5-year single-centre experience. HPB (Oxford) 2011; 13 (10) 745-752
    CrossrefPubMedGoogle Scholar
  • 19 Hadden WJ, de Reuver PR, Brown K, Mittal A, Samra JS, Hugh TJ. Resection of colorectal liver metastases and extra-hepatic disease: a systematic review and proportional meta-analysis of survival outcomes. HPB (Oxford) 2016; 18 (03) 209-220
    CrossrefPubMedGoogle Scholar
  • 20 Wang K, Liu W, Yan XL, Xing BC. Role of a liver-first approach for synchronous colorectal liver metastases. World J Gastroenterol 2016; 22 (06) 2126-2132
    CrossrefPubMedGoogle Scholar
  • 21 Su YM, Liu W, Yan XL. et al. Five-year survival post hepatectomy for colorectal liver metastases in a real-world Chinese cohort: Recurrence patterns and prediction for potential cure. Cancer Med 2023; 12 (08) 9559-9569
    CrossrefPubMedGoogle Scholar
  • 22 Adam R, Delvart V, Pascal G. et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 2004; 240 (04) 644-657 , discussion 657–658
    CrossrefPubMedGoogle Scholar
  • 23 Wong GYM, Mol B, Bhimani N. et al. Recurrence patterns predict survival after resection of colorectal liver metastases. ANZ J Surg 2022; 92 (09) 2149-2156
    CrossrefPubMedGoogle Scholar
  • 24 Viganò L, Capussotti L, Lapointe R. et al. Early recurrence after liver resection for colorectal metastases: risk factors, prognosis, and treatment. A LiverMetSurvey-based study of 6,025 patients. Ann Surg Oncol 2014; 21 (04) 1276-1286
    CrossrefPubMedGoogle Scholar
  • 25 Buisman FE, Galjart B, van der Stok EP. et al. Recurrence patterns after resection of colorectal liver metastasis are modified by perioperative systemic chemotherapy. World J Surg 2020; 44 (03) 876-886
    CrossrefPubMedGoogle Scholar
  • 26 Sasaki K, Morioka D, Conci S. et al. The tumor burden score: a new ‘metro-ticket’ prognostic tool for colorectal liver metastases based on tumor size and number of tumors. Ann Surg 2018; 267 (01) 132-141
    CrossrefPubMedGoogle Scholar
  • 27 Poultsides GA, Servais EL, Saltz LB. et al. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol 2009; 27 (20) 3379-3384
    CrossrefPubMedGoogle Scholar
  • 28 Laurent C, Sa Cunha A, Couderc P, Rullier E, Saric J. Influence of postoperative morbidity on long-term survival following liver resection for colorectal metastases. Br J Surg 2003; 90 (09) 1131-1136
    CrossrefPubMedGoogle Scholar
  • 29 Chow FC, Chok KS. Colorectal liver metastases: An update on multidisciplinary approach. World J Hepatol 2019; 11 (02) 150-172
    CrossrefPubMedGoogle Scholar
  • 30 Zendel A, Lahat E, Dreznik Y, Zakai BB, Eshkenazy R, Ariche A. “Vanishing liver metastases”-A real challenge for liver surgeons. Hepatobiliary Surg Nutr 2014; 3 (05) 295-302
    PubMedGoogle Scholar