Approach to synchronous liver metastases from colorectal carcinoma - results from a Portuguese reference center

Abstract

About 15%-25% of patients with colorectal cancer, have synchronous liver metastases. The best surgical approach for the patients with asymptomatic primary colorectal tumor and synchronous liver metastases is still the subject of much debate. We aimed to evaluate the perioperative and long-term results as well as to identify possible prognostic factors of the two strategies:  liver- first and synchronous resection. Observational, retrospective study, which included patients with synchronous liver metastases from colorectal cancer, who underwent liver surgery between January 2016 and December 2021, in a Portuguese reference center. Patients were divided into two groups according to the therapeutic approach (synchronous resections vs Liver First) and into three groups according to the hepatic tumor burden (single liver lesion versus more than three liver lesions versus bilobar lesions). To determine the overall and disease-free survival, Kaplan-Meier curves and the log-rank test were performed and, to identify factors with an impact on the prognosis, a univariate and multivariate analysis were performed with the application of Cox regression (significance of 5%). Among the 46 patients included, 54,4% underwent the liver-first approach and 21 patients (45.7%) underwent simultaneous resection. The liver-first group had a greater number of patients with primary rectal tumor (84% vs.14.3%; p<0.001), with more than 3 hepatic lesions (56% vs.14%; p=0.004) and with more extensive hepatic resection. As for postoperative morbimortality, no statistically significant difference was observed between the two approaches (p=0.514). The median overall survival was similar even when considering the hepatic tumor burden (35.0 months (95%CI 15.91- 54.09) in the liver-first group vs. 48.0 months (95%CI 21.69-74.96) in the synchronous resection group; p=0.145). The same was observed for the median disease-free survival (16.0 months (95% CI 0-32.7) vs. 23.0 months (95% CI 16.3-29.7) p=0.651, respectively). The two strategies showed similar morbidity. No statistically significant difference was observed with regard to overall and disease-free survival even when the hepatic tumor burden was considered. One-year and three-year survival were also similar. However, it should be stressed that, the choice of the surgical approach for each group did not took into account the hepatic tumor burden, which we believe it is essential in choosing the best surgical approach.The existence of a multidisciplinary team is fundamental for the therapeutic success of these patients.