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A Survival Analysis of the Liver-First Reversed Management of Advanced Simultaneous Colorectal Liver Metastases: A LiverMetSurvey-Based Study

Andres, Axel MD*; Toso, Christian MD, PhD*; Adam, Rene MD, PhD; Barroso, Eduardo MD; Hubert, Catherine MD§; Capussotti, Lorenzo MD; Gerstel, Eric MD*; Roth, Arnaud MD*; Majno, Pietro E. MD*; Mentha, Gilles MD*

doi: 10.1097/SLA.0b013e3182734423
Original Articles From the ESA Proceedings

Background: Liver-first reversed management (RM) for the treatment of patients with simultaneous colorectal liver metastases (CRLM) includes liver-directed chemotherapy, the resection of the CRLM, and the subsequent resection of the primary cancer. Retrospective data have shown that up to 80% of patients can successfully undergo a complete RM, whereas less than 30% of those undergoing classical management (CM) do so. This registry-based study compared the 2 approaches.

Methods: The study was based on the LiverMetSurvey (January 1, 2000 to December 31, 2010) and included patients with 2 or more metastases. All patients had irinotecan and/or oxaliplatin-based chemotherapy before liver surgery. Patients undergoing simultaneous liver and colorectal surgery were excluded.

Results: A total of 787 patients were included: 729 in the CM group and 58 in the RM group. Patients in the 2 groups had similar numbers of metastases (4.20 vs 4.80 for RM and CM, P = 0.231) and Fong scores of 3 or more (79% vs 87%, P = 0.164). Rectal cancer, neoadjuvant rectal radiotherapy, and the use of combined irinotecan/oxaliplatin chemotherapy were more frequent in the RM group (P < 0.001), whereas colorectal lymph node involvement was more frequent in the CM group (P < 0.001). Overall survival and disease-free survival were similar in the RM and CM groups (48% vs 46% at 5 years, P = 0.965 and 30% vs 26%, P = 0.992).

Conclusions: Classical and reversed managements of metastatic liver disease in colorectal cancer are associated with similar survival when successfully completed.

Liver-first reversed management for the treatment of patients with colorectal cancer and simultaneous liver metastases (CRLM) includes liver-directed chemotherapy, the resection of the CRLM, and the subsequent resection of the primary cancer. Classical and reversed managements of metastatic liver disease in colorectal cancer are associated with similar survival when successfully completed.

*Abdominal and Transplantation Surgery, Geneva University Hospital, Geneva, Switzerland

AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France

Centro Hepato-bilio-pancreatico e de Transplantacao do Hospital de Curry Cabral, Lisboa, Portugal

§Department of Abdominal Surgery and Transplantation, Division of Hepato-Biliary and Pancreatic Surgery, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

Department of Hepatopancreatobiliary and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy.

Reprints: Gilles Mentha, MD, Transplantation Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Geneva, Switzerland. E-mail: gilles.mentha@hcuge.ch.

LiverMetSurvey is supported by an unrestricted grant from Sanofi-Aventis.

C.T. was supported by the Swiss National Science Foundation (SCORE grant 3232230-126233).

None of the authors declare any conflict of interest.

Disclosure: The authors declare that they have nothing to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.