Team strategy optimization in combined resections for synchronous colorectal liver metastases. A comparative study with bootstrapping analysis

Background: Although a ‘liver-first' approach recently has been advocated in treating synchronous colorectal metastases, little is known about how results compare with those of the classical approach among patients with similar grades of liver metastases. Methods: Propensity-score matching was used to select study subjects. Oncologic outcomes were compared between 10 consecutive patients with unresectable advanced and aggressive synchronous colorectal liver metastases treated with the reverse strategy and 30 comparable classically treated patients. Results: Numbers of recurrence sites and recurrent tumors irrespective of recurrence sites were greater in the reverse group then the classic group (p = 0.003 and p = 0.015, respectively). Rates of freedom from recurrence in the remaining liver and of freedom from disease also were poorer in the reverse group than in the classical group (p = 0.009 and p = 0.043, respectively). Among patients treated with 2-stage hepatectomy, frequency of microvascular invasion surrounding macroscopic metastases at second resection was higher in the reverse group than in the classical group (p = 0.011). Conclusions: Reverse approaches may be feasible in treating synchronous liver metastases, but that strategy should be limited to patients with less liver tumor burden.

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Defining an optimal surgical strategy for synchronous colorectal liver metastases: staged versus simultaneous resection?

ANZ Journal of Surgery ◽

10.1111/ans.12739 ◽

2014 ◽

Vol 85 (11) ◽

pp. 829-833 ◽

Cited By ~ 6

Author(s):

Wong Hoi She ◽

Albert Chi Yan Chan ◽

Ronnie Tung Ping Poon ◽

Tan To Cheung ◽

Kenneth Siu Ho Chok ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Surgical Strategy ◽

Simultaneous Resection ◽

Synchronous Colorectal Liver Metastases

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Feasibility of “Watch-and-Wait” Management before Repeat Hepatectomy for Colorectal Liver Metastases

Digestive Surgery ◽

10.1159/000488217 ◽

2018 ◽

Vol 36 (3) ◽

pp. 233-240 ◽

Cited By ~ 1

Author(s):

Yoji Kishi ◽

Satoshi Nara ◽

Minoru Esaki ◽

Kazuaki Shimada

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Repeat Hepatectomy ◽

Hepatic Recurrence ◽

Free Interval ◽

Tumor Number ◽

Group A ◽

Synchronous Colorectal Liver Metastases ◽

Group B ◽

Better Than

Background: Whether repeat hepatectomy for colorectal liver metastases should be performed after chemotherapy or observation is unclear. Methods: We selected patients with resectable hepatic recurrence after their first hepatectomies performed between 2000 and 2015. They were classified according to the further treatment: Group A, prompt repeat hepatectomy; Group B, observation; and Group C, ≤6 months of chemotherapy. In Group B/C, patients who later underwent hepatectomy and those who did not due to disease progression were classified as B1/C1 and B2/C2, respectively. Predictors of B2/C2 were evaluated. Results: Groups A, B, and C consisted of 81, 36, and 17 patients, respectively. Recurrence-free interval was longer in Group A (median months; Group A, 10.3; Group B, 5.7; Group C, 3.5; p < 0.01). Group B1/C1 and B2/C2 included 34 and 19 patients, respectively. Five-year survival after recurrence of Group B1/C1 was 56%, which was comparable with Group A (56%, p = 0.77) and better than Group B2/C2 (0%, p < 0.01). Multivariate analysis showed synchronous colorectal liver metastases (OR 7.23) and recurrent hepatic tumor number (OR 4.04) were predictors of tumor progression. Conclusion: Selecting patients optimally either for prompt or delayed repeat hepatectomy following chemotherapy or observation is a feasible strategy.

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