A comparison of the simultaneous, liver-first, and colorectal-first strategies for surgical treatment of synchronous Colorectal Liver Metastases at two major liver-surgery institutions in Sweden

• BackgroundThe optimal treatment strategy for patients with synchronous colorectal liver metastases is unclear. The aim of this study was to compare the outcome of the simultaneous, liver-first, and colorectal-first surgical approaches.   MethodsAll consecutive patients with synchronous colorectal liver metastases who underwent liver resection with curative intent were included. Data were collected from local databases. Patient and tumour specific characteristics were retrieved, and clinicopathological factors were analysed. A Cox regression model was constructed, and a subgroup intention-to-treat analysis was performed after propensity score matching.  ResultsA total of 658 patients were included in the analysis. Ninety-two patients had a simultaneous resection, 163 patients had liver-first, and 403 patients had a colorectal-first approach. After matching, two balanced groups between the simultaneous and liver-first groups were created with 58 patients in each. There were no differences in post-operative complications defined as Clavien-Dindo 3a (p=0.992), and >3a (p=0.999). There were no differences in overall survival between the groups (stratified log rank p=0.455). The median overall survival for liver-first was 42.2 (26.3-58.2) months, and for the  simultaneous groups, 56.2 (47.1-65.4). ConclusionThe simultaneous approach was not associated with worse overall survival compared to a staged approach, and had comparable morbidity and mortality.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

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Medicinsk vetenskap

Medical Science

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