Surgical Management of Synchronous Colorectal Liver Metastases: A Multicenter Study Comparing Classic, Combined and Reverse Strategy
Journal Title: Saudi Journal of Medicine - Year 2018, Vol 3, Issue 6
Abstract
Abstract: Optimal management sequence for the primary tumor and the liver in synchronous colorectal liver metastases (SCLM) is still controversial. Except reviews, studies comparing the 3 surgical approaches are infrequent. The present study aimed to describe the surgical management of patients operated of SCLM. In particular, we compared short-term outcomes and survival according to the surgical strategy. A multicentric retrospective study was conducted on 125 patients with SCLM. Surgical strategy was defined as classic (colorectal first approach), combined and reverse (liver-first approach). Between 2008 and 2013, 87 patients completed the classic strategy, 24 combined strategy and 14 reverse strategy. The 3 groups were comparable regarding pre-operative data. Liver metastases involvement was significantly higher in reverse group. Severe cumulative postoperative morbidity was 39.2%, similar between the 3 strategies. Ninety-day mortality was higher in combined group (12.5%, p>0.05). Failure rate of liver first approach was 17%. The 3-year overall survival (OS) was 73% in classic group, 78% in combined group and 93% in reverse group. The 3-year disease free survival (DFS) was 29%, 30% and 19% for classic, combined and reverse strategy respectively. There was no significant difference with regard to OS and DFS between 3 groups. We demonstrated that liver first approach is safe and feasible with acceptable perioperative and survival outcomes despite initially worse prognostic criteria. Reverse strategy can be applied to a vast majority of patients independently to the liver tumor burden and should be considered progressively as a reference in the management of SCLM. Keywords: Synchronous colorectal liver metastases, comparative study, reverse strategy, liver-first approach.
Authors and Affiliations
P. Chirac, M. Adham, Kayvan Mohkam, O. Glehen, C Ducerf, G. Passot
Keywords
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