Impact of the strategy for curative treatment of synchronous colorectal cancer liver metastases.

ABSTRACT

AIM OF THE STUDY Fourteen to seventeen percent of patients suffering from colorectal cancer have synchronous liver metastases (sCRLM) at the time of diagnosis. There are currently three possible strategies for curative management of sCRLM "classic", "combined", and "liver-first". The aim of our research was to analyze the effects of the three surgical management strategies for sCRLM on postoperative morbidity and mortality and overall and recurrence-free survival. PATIENTS AND METHODS: Patients treated for sCRLM between October 2000 and May 2015 were included. We defined three groups (1) "classic" surgery of primary tumor and then surgery of sCRLM; (2) "combined" combined surgery of primary tumor and sCRLM and (3) "liver-first" surgery of sCRLM and then surgery of primary tumor. RESULTS: During this period, 170 patients who underwent 209 hepatectomies were included ("classic" 149, "combined" 34, "liver-first" 26). The rate of severe complications was higher in the "combined" group compared to the "classic" group (35% vs. 12%, P=0.03), and the "liver-first" group (35% vs. 19%, P=0.25), while there were significantly fewer liver resections. Overall survival at 5 years in our cohort was 46%, without significant differences between the groups, and a median survival of 54 months. Recurrence-free survival of the patients in our cohort was 24% at 5 years, with a median survival time without recurrence of 14 months, without significant differences between the groups. CONCLUSION: All three strategies were feasible and there were no differences regarding overall and recurrence-free survivals between the three approaches. The "combined" strategy group had significantly more severe complications and did not provide better oncological results, despite less aggressive liver disease and more limited liver resections.