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Herrero Fonollosa E, Galofré Recasens M, Zárate Pinedo A, García Domingo MI, Camps Lasa J, Pardo Aranda F, Espin Álvarez F, Cugat Andorrà E. Long-term results of liver-first approach strategy in patients with advanced synchronous liver metastases from colorectal cancer. Cir Esp 2023; 101:341-349. [PMID: 35667607 DOI: 10.1016/j.cireng.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/15/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND The "liver-first" approach (LFA) is a strategy indicated for advanced synchronous liver metastases (ASLM) from colorectal cancer (CRC). Includes neoadjuvant chemotherapy, resection of the ASLM followed by CRC resection. METHODS Retrospective descriptive analysis from a prospective database of hepatectomies from liver metastases (LM) from CRC in two centers. Between 2007-2019, 88 patients with CRC-ASLM were included in a LFA scheme. Bilobar (LM) was present in 65.9%, the mean number of lesions was 5.5 and mean size 42.7 mm. Response to treatment was assessed by RECIST criteria. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier survival curves. RESULTS Seventy-five of 88 patients (85.2%) completed the LFA. RECIST evaluation showed partial response in 75.7% and stable disease in 22.8%. Severe morbidity rate (Clavien-Dindo ≥ IIIA) after liver and colorectal surgery was present in 29.4% and 9.3%, respectively. There was no 90-day postoperative mortality in both liver and colorectal surgeries. Recurrence rate was 76%, being the liver the most frequent site, followed by the pulmonary. From the total number of recurrences (106) in 56 patients, surgical with chemotherapy rescue treatment was accomplished in 34 of them (32.1%). The mean PFS was 8.5 and 5-year OS was 53%. CONCLUSIONS In patients with CRC-ASLM the LFA allows control of the liver disease beforehand and an assessment of the tumor response to neoadjuvant chemotherapy, optimising the chance of potentially curative liver resection, which influences long-term survival.
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Affiliation(s)
- Eric Herrero Fonollosa
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain.
| | - María Galofré Recasens
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Alba Zárate Pinedo
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria Isabel García Domingo
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Judith Camps Lasa
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Fernando Pardo Aranda
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Francisco Espin Álvarez
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Esteban Cugat Andorrà
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain; Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Herrero Fonollosa E, Galofré Recasens M, Zárate Pinedo A, García Domingo MI, Camps Lasa J, Pardo Aranda F, Espin Álvarez F, Cugat Andorrà E. Análisis retrospectivo de los resultados a largo plazo de la estrategia inversa en pacientes con cáncer colorrectal y enfermedad hepática metastásica sincrónica avanzada. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Burasakarn P, Thienhiran A, Hongjinda S, Fuengfoo P. Evaluating the Outcomes of Liver‐first Approach for Liver Metastases due to Colorectal Cancer: A Systematic Review and Meta‐analysis. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Pipit Burasakarn
- Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai Ratchathewi, Bangkok Thailand
| | - Anuparb Thienhiran
- Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai Ratchathewi, Bangkok Thailand
| | - Sermsak Hongjinda
- Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai Ratchathewi, Bangkok Thailand
| | - Phusit Fuengfoo
- Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai Ratchathewi, Bangkok Thailand
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Zeyara A, Torén W, Søreide K, Andersson R. The liver-first approach for synchronous colorectal liver metastases: A systematic review and meta-analysis of completion rates and effects on survival. Scand J Surg 2021; 111:14574969211030131. [PMID: 34605325 DOI: 10.1177/14574969211030131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients presenting with synchronous colorectal liver metastases are increasingly being considered for a curative treatment, and the liver-first approach is gaining popularity in this context. However, little is known about the completion rates of the liver-first approach and its effects on survival. METHODS A systematic review and meta-analysis of liver-first strategy for colorectal liver metastasis. The primary outcome was an assessment of the completion rates of the liver-first approach. Secondary outcomes included overall survival, causes of non-completion, and clinicopathologic data. RESULTS Seventeen articles were amenable for inclusion and the total study population was 1041. The median completion rate for the total population was 80% (range 20-100). The median overall survival for the completion and non-completion groups was 45 (range 12-69) months and 13 (range 10.5-25) months, respectively. Metadata showed a significant survival benefit for the completion group, with a univariate hazard ratio of 12.0 (95% confidence interval, range 5.7-24.4). The major cause of non-completion (76%) was liver disease progression before resection of the primary tumor. Pearson tests showed significant negative correlation between median number of lesions and median size of the largest metastasis and completion rate. CONCLUSIONS The liver-first approach offers a complete resection to most patients enrolled, with an overall survival benefit when completion can be assured. One-fifth fails to return to intended oncologic therapy and the major cause is interim metastatic progression, most often in the liver. Risk of non-completion is related to a higher number of lesions and large metastases. The majority of studies stem from primary rectal cancers, which may influence on the return to intended oncologic therapy as well.PROSPERO id no: 170459.
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Affiliation(s)
- Adam Zeyara
- Department of Surgery, Ystad Hospital, Ystad, Sweden Department of Clinical Sciences, Lund University, Lund, Sweden
| | - William Torén
- Department of Clinical Sciences, Lund University, Lund, Sweden Department of Surgery, Skåne University Hospital, Lund, SwedenKjetil Søreide
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Roland Andersson
- Department of Surgery, Skåne University Hospital, Lund SE-222 42, Sweden
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Du Pasquier C, Roulin D, Bize P, Sempoux C, Rebecchini C, Montemurro M, Schäfer M, Halkic N, Demartines N. Tumor response and outcome after reverse treatment for patients with synchronous colorectal liver metastasis: a cohort study. BMC Surg 2020; 20:78. [PMID: 32306936 PMCID: PMC7169034 DOI: 10.1186/s12893-020-00738-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 04/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The reverse treatment of patients with synchronous colorectal liver metastases (CRLM) is a sequential approach with systemic chemotherapy first, followed by liver resection, and finally, primary tumor resection. The aim of this study was to assess the feasibility, the radiological and pathological tumor response to neoadjuvant therapy, recurrence rates and long-term survival after reverse treatment in a cohort study. METHODS Data from patients with CRLM who underwent a reverse treatment from August 2008 to October 2016 were extracted from our prospective hepato-biliary database and retrospectively analyzed for response rates and survival outcomes. Radiological tumor response was assessed by RECIST (Response Evaluation Criteria In Solid Tumor) criteria and pathological response according to TRG (Tumor Regression Grade). Disease-free and overall survival were estimated with Kaplan-Meier survival curves. RESULTS There were 44 patients with 19 rectal and 25 colonic tumors. The reverse treatment was fully completed until primary tumor resection in 41 patients (93%). Radiological assessment after chemotherapy showed 61% of complete/partial response. Pathological tumor response was major or partial in 52% of patients (TRG 1-3). Median disease-free survival after primary tumor resection was 10 months (95% CI 5-15 months). Disease-free survival at 3 and 5 years was 25% and 25%, respectively. Median overall survival was 50 months (95% CI 42-58 months). Overall survival at 3 and 5 years was 59% and 39%, respectively. CONCLUSION The reverse treatment approach was feasible with a high rate of patients with complete treatment sequence and offers promising long-term survival for selected patients with advanced simultaneous colorectal liver metastases.
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Affiliation(s)
- Céline Du Pasquier
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Department of Pathology, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Didier Roulin
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Department of Pathology, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Pierre Bize
- Department of Radiology, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Christine Sempoux
- Department of Pathology, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Caterina Rebecchini
- Department of Pathology, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Michael Montemurro
- Department of Medical Oncology, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Ghiasloo M, Pavlenko D, Verhaeghe M, Van Langenhove Z, Uyttebroek O, Berardi G, Troisi RI, Ceelen W. Surgical treatment of stage IV colorectal cancer with synchronous liver metastases: A systematic review and network meta-analysis. Eur J Surg Oncol 2020; 46:1203-1213. [PMID: 32178961 DOI: 10.1016/j.ejso.2020.02.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/13/2019] [Accepted: 02/29/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The ideal treatment approach for colorectal cancer (CRC) with synchronous liver metastases (SCRLM) remains debated. We performed a network meta-analysis (NMA) comparing the 'bowel-first' approach (BFA), simultaneous resection (SIM), and the 'liver-first' approach (LFA). METHODS A systematic search of comparative studies in CRC with SCRLM was undertaken using the Embase, PubMed, Web of Science, and CENTRAL databases. Outcome measures included postoperative complications, 30- and 90-day mortality, chemotherapy use, treatment completion rate, 3- and 5-year recurrence-free survival, and 3- and 5-year overall survival (OS). Pairwise and network meta-analysis were performed to compare strategies. Heterogeneity was assessed using the Higgins I2 statistic. RESULTS One prospective and 43 retrospective studies reporting on 10 848 patients were included. Patients undergoing the LFA were more likely to have rectal primaries and a higher metastatic load. The SIM approach resulted in a higher risk of major morbidity and 30-day mortality. Compared to the BFA, the LFA more frequently resulted in failure to complete treatment as planned (34% versus 6%). Pairwise and network meta-analysis showed a similar 5-year OS between LFA and BFA and a more favorable 5-year OS after SIM compared to LFA (odds ratio 0.25-0.90, p = 0.02, I2 = 0%), but not compared to BFA. CONCLUSION Despite a higher tumor load in LFA compared to BFA patients, survival was similar. A lower rate of treatment completion was observed with LFA. Uncertainty remains substantial due to imprecise estimates of treatment effects. In the absence of prospective trials, treatment of stage IV CRC patients should be individually tailored.
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Affiliation(s)
- Mohammad Ghiasloo
- Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Belgium; Department of Surgery, Division of GI Surgery, Ghent University Hospital, Belgium
| | - Diana Pavlenko
- Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Belgium
| | - Marzia Verhaeghe
- Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Belgium
| | - Zoé Van Langenhove
- Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Belgium
| | - Ortwin Uyttebroek
- Department of Surgery, Division of General and HPB Surgery, Ghent University Hospital, Belgium
| | - Giammauro Berardi
- Department of Surgery, Division of General and HPB Surgery, Ghent University Hospital, Belgium
| | - Roberto I Troisi
- Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Belgium; Department of Clinical Medicine and Surgery, Federico II University Naples, Italy
| | - Wim Ceelen
- Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Belgium; Department of Surgery, Division of GI Surgery, Ghent University Hospital, Belgium; Cancer Research Institute Ghent (CRG), Ghent University, Belgium.
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7
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A meta-analysis of liver-first versus classical strategy for synchronous colorectal liver metastases. Int J Colorectal Dis 2020; 35:537-546. [PMID: 31955217 DOI: 10.1007/s00384-020-03503-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to compare the perioperative outcomes of liver-first (LFS) and classical (CS) strategy for the management of synchronous colorectal liver metastases (sCRLM). METHOD A literature search was performed in PubMed, Scopus, and Cochrane databases, in accordance with the PRISMA guidelines. The odds ratio, weighted mean difference, and 95% confidence interval were evaluated by means of the random-effects model. RESULTS Ten articles met the inclusion criteria, incorporating 3656 patients. Patients in the LFS group reported increased size of sCRLM and a higher rate of major hepatectomies. This study reveals comparable overall survival and disease-free survival at 1, 3, and 5 years postoperatively between the two strategies. Moreover, the mean operative time, length of hospital stay, the incidence of severe complications, and the 30-day and 90-day mortality were similar between the two groups. The mean intraoperative blood loss was significantly increased in the LFS group. CONCLUSION These outcomes suggest that both approaches are feasible and safe. Given the lack of randomized clinical trials, this meta-analysis represents the best currently available evidence. However, the results should be treated with caution given the small number of the included studies. Randomized trials comparing LFS to CS are necessary to further evaluate their outcomes.
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8
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Gavriilidis P, Katsanos K, Sutcliffe RP, Simopoulos C, Azoulay D, Roberts KJ. Simultaneous, Delayed and Liver-First Hepatic Resections for Synchronous Colorectal Liver Metastases: A Systematic Review and Network Meta-Analysis. J Clin Med Res 2019; 11:572-582. [PMID: 31413769 PMCID: PMC6681858 DOI: 10.14740/jocmr3887] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 06/17/2019] [Indexed: 12/22/2022] Open
Abstract
Background Systematic reviews and meta-analyses that compare simultaneous, delayed and liver-first approach for synchronous colorectal liver metastases have found no significant differences. The aim of this study was to determine the best treatment strategy on the basis of effect sizes and the probabilities of treatment ranking by using a network meta-analysis. Moreover, first-time pairwise and network meta-analyses were used to estimate the existing evidence, and their results were compared to detect any discrepancies between them. Methods Systematic review, pairwise meta-analysis and network meta-analysis were performed. The primary and secondary outcomes were 5-year overall survival and postoperative major morbidity, respectively. Results No significant differences in long-term survival and major morbidity were found amongst the three approaches. The hazard ratios (95% confidence interval) for 5-year overall survival for the simultaneous, delayed and liver-first approaches were 0.93 (0.69 - 1.24, P = 0.613), 0.97 (0.87 - 1.07, P = 0.596) and 0.90 (0.67 - 1.22, P = 0.499), respectively. Moreover, the liver-first approach with a surface under the cumulative ranking area score of 89% was ranked as the potentially best treatment option based on probabilities of treatment ranking. Conclusions On the basis of the relative ranking of treatments, the liver-first approach ranked first, followed by the delayed and simultaneous approaches. Therefore, a three-arm randomized controlled trial that compares the liver-first, simultaneous and delayed approaches needs to shed further light as to which is the best treatment option.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Konstantinos Katsanos
- Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion, 26504 Patras, Greece
| | - Robert P Sutcliffe
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Constantinos Simopoulos
- The 2nd Department of Surgery, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Daniel Azoulay
- Department of Hepato-Pancreato-Biliary and Liver Transplantation, Henri Mondor University Hospital, 94010 Creteil, France
| | - Keith J Roberts
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
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de Jong MC, Beckers RCJ, van Woerden V, Sijmons JML, Bemelmans MHA, van Dam RM, Dejong CHC. The liver-first approach for synchronous colorectal liver metastases: more than a decade of experience in a single centre. HPB (Oxford) 2018; 20:631-640. [PMID: 29456199 DOI: 10.1016/j.hpb.2018.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 10/19/2017] [Accepted: 01/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The feasibility of the liver-first approach for synchronous colorectal liver metastases (CRLM) has been established. We sought to assess the short-term and long-term outcomes for these patients. METHODS Outcomes of patients who underwent a liver-first approach for CRLM between 2005 and 2015 were retrospectively evaluated from a prospective database. RESULTS Of the 92 patients planned to undergo the liver-first strategy, the paradigm could be completed in 76.1%. Patients with concurrent extrahepatic disease failed significantly more often in completing the protocol (67% versus 21%; p = 0.03). Postoperative morbidity and mortality were 31.5% and 3.3% following liver resection and 30.9% and 0% after colorectal surgery. Of the 70 patients in whom the paradigm was completed, 36 patients (51.4%) developed recurrent disease after a median interval of 20.9 months. The median overall survival on an intention-to-treat basis was 33.1 months (3- and 5-year overall survival: 48.5% and 33.1%). Patients who were not able to complete their therapeutic paradigm had a significantly worse overall outcome (p = 0.03). CONCLUSION The liver-first approach is feasible with acceptable perioperative morbidity and mortality rates. Despite the considerable overall-survival-benefit, recurrence rates remain high. Future research should focus on providing selection tools to enable the optimal treatment sequence for each patient with synchronous CRLM.
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Affiliation(s)
- Mechteld C de Jong
- Department of Surgery - Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
| | - Rianne C J Beckers
- Department of Radiology - Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands; GROW - School for Oncology & Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Victor van Woerden
- Department of Surgery - Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Julie M L Sijmons
- Faculty of Health, Medicine & Life Sciences - Maastricht University, The Netherlands
| | - Marc H A Bemelmans
- Department of Surgery - Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Ronald M van Dam
- Department of Surgery - Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Cornelis H C Dejong
- Department of Surgery - Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands; NUTRIM - School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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Primary Tumor Versus Liver-First Approach for Synchronous Colorectal Liver Metastases: An Association Française de Chirurgie (AFC) Multicenter-Based Study with Propensity Score Analysis. World J Surg 2018; 42:4046-4053. [PMID: 29947991 DOI: 10.1007/s00268-018-4711-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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11
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Lim C, Doussot A, Osseis M, Esposito F, Salloum C, Calderaro J, Tournigand C, Azoulay D. Bevacizumab improves survival in patients with synchronous colorectal liver metastases provided the primary tumor is resected first. Clin Transl Oncol 2018; 20:1274-1279. [PMID: 29594943 DOI: 10.1007/s12094-018-1858-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/06/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Multimodal strategy including chemotherapy and hepatectomy is advocated for the management of colorectal liver metastases (CRLM). The aim of this study was to evaluate the impact of neoadjuvant Bevacizumab-based chemotherapy on survival in patients with resected stage IVA colorectal cancer and liver metastases. METHODS Data from 120 consecutive patients who received neoadjuvant chemotherapy and underwent curative-intent hepatectomy for synchronous CRLM were retrospectively reviewed. Overall survival (OS) was stratified according to administration of Bevacizumab before liver resection and surgical strategy, i.e., classical strategy (primary tumor resection first) versus reverse strategy (liver metastases resection first). RESULTS Patients who received Bevacizumab (n = 37; 30%) had a higher number of CRLM (p = 0.003) and underwent more often reverse strategy (p = 0.005), as compared to those who did not (n = 83; 70%). Bevacizumab was associated with an improved OS compared with conventional chemotherapy (p = 0.04). After stratifying by the surgical strategy, Bevacizumab was associated with improved OS in patients who had classical strategy (p = 0.03). In contrast, Bevacizumab had no impact on OS among patients who had liver metastases resection first (p = 0.89). CONCLUSIONS Neoadjuvant Bevacizumab-based chemotherapy was associated with improved OS in patients who underwent liver resection of synchronous CRLM, especially in those who underwent primary tumor resection first.
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Affiliation(s)
- C Lim
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny, 94010, Créteil, France
| | - A Doussot
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny, 94010, Créteil, France
| | - M Osseis
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny, 94010, Créteil, France
| | - F Esposito
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny, 94010, Créteil, France
| | - C Salloum
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny, 94010, Créteil, France
| | - J Calderaro
- Université Paris-Est UPEC, Créteil, France
- INSERM, U955, Créteil, France
- Department of Pathology, Henri Mondor Hospital, Créteil, France
| | - C Tournigand
- Department of Oncology, Henri Mondor Hospital, Créteil, France
| | - D Azoulay
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny, 94010, Créteil, France.
- Université Paris-Est UPEC, Créteil, France.
- INSERM, U955, Créteil, France.
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Lim C, Doussot A, Osseis M, Salloum C, Gomez Gavara C, Compagnon P, Brunetti F, Calderaro J, Azoulay D. Primary Tumor Versus Liver-First Strategy in Patients with Stage IVA Colorectal Cancer: A Propensity Score Analysis of Long-term Outcomes and Recurrence Pattern. Ann Surg Oncol 2016; 23:3024-3032. [DOI: 10.1245/s10434-016-5265-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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13
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Feasibility of the liver-first approach for patients with initially unresectable and not optimally resectable synchronous colorectal liver metastases. Surg Today 2015; 46:721-8. [DOI: 10.1007/s00595-015-1242-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/21/2015] [Indexed: 02/07/2023]
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14
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Waisberg J, Ivankovics IG. Liver-first approach of colorectal cancer with synchronous hepatic metastases: A reverse strategy. World J Hepatol 2015; 7:1444-1449. [PMID: 26085905 PMCID: PMC4462684 DOI: 10.4254/wjh.v7.i11.1444] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/22/2015] [Accepted: 04/14/2015] [Indexed: 02/06/2023] Open
Abstract
Recently, there has been a change in the strategy of how synchronous colorectal hepatic metastases are attributed to the development of more valuable protocols of chemotherapy and radiotherapy for neoadjuvant treatment of colorectal neoplasms and their hepatic metastases. There is a consensus that patients with synchronous colorectal hepatic metastases have lower survival than those with metachronous colorectal hepatic metastases. Currently, controversy remains concerning the best approach is sequence in a patient with colorectal cancer and synchronous hepatic metastases resection. To obtain a better patient selection, the authors have suggested the initial realization of systemic chemotherapy in the circumstance of patients with colorectal tumor stage IV, since these patients have a systemic disease. The rationale behind this liver-first strategy is initially the control of synchronous hepatic metastases of colorectal carcinoma, which can optimize a potentially curative hepatic resection and longstanding survival. The liver-first strategy procedure is indicated for patients with colorectal hepatic metastases who require downstaging therapy to make a curative liver resection possible. Thus, the liver-first strategy is considered an option in cases of rectal carcinoma in the early stage and with limited or advanced synchronous colorectal hepatic metastases or in case of patients with asymptomatic colorectal carcinoma, but with extensive liver metastases. Patients undergoing systemic chemotherapy and with progression of neoplastic disease should not undergo hepatic resection, because it does not change the prognosis and may even make it worse. To date, there have been no randomized controlled trials on surgical approach of colorectal synchronous hepatic metastases, despite the relatively high number of available manuscripts on this subject. All of these published studies are observational, usually retrospective, and often non-comparative. The patient selection criteria for the liver-first strategy should be individualized, and the approach of these patients should be performed by a multidisciplinary team so its benefits will be fully realized.
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