Liver-First Resection in Patients With Synchronous Colorectal Liver Metastases Is Associated with Inferior Recurrence-Free Survival: Reconsidering the Importance of the Primary Cancer.

IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Thomas L Sutton,Ranish K Patel,Katherine M Watson,Ivy H Gardner,Daniel O Herzig,V Liana Tsikitis,Emerson Y Chen,Skye C Mayo
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引用次数: 0

Abstract

BACKGROUND Synchronous colorectal liver metastases may be managed with primary-first, simultaneous, or liver-first resection. Relative oncologic outcomes based upon treatment sequencing are understudied. OBJECTIVE This study aimed to assess oncologic survival outcomes in patients with synchronous colorectal liver metastases managed with each of the three treatment strategies, with respect to early or delayed removal of the primary tumor. DESIGN Retrospective analysis of prospectively maintained database, with 1:1 propensity-matching of relevant clinicopathologic variables comparing liver-first to primary-first/simultaneous approaches. SETTINGS Single-institution, tertiary cancer center. PATIENTS Patients undergoing curative-intent hepatectomy for synchronous colorectal liver metastases from 2003-2019. MAIN OUTCOME MEASURES Overall and recurrence-free survival. RESULTS Of 151 patients, 23% (n = 35) had liver-first and 77% (n = 116; primary-first = 93 and simultaneous = 23) had primary-first/simultaneous approaches. Median follow-up was 45 months. Recurrence-free survival was worse for liver-first versus primary-first/simultaneous groups (median 12 versus 16 months, p = 0.02), driven by three-year extrahepatic recurrence-free survival of 19%, 58%, and 50% for liver-first, primary-first, and simultaneous groups, respectively. Three-year overall survival was not significantly different at 86%, 79%, and 86%, respectively. Oncologic outcomes did not significantly differ between primary-first and simultaneous groups (all p > 0.4). Matching yielded 34 clinicopathologically similar patients per group (liver-first = 34, primary-first = 28/simultaneous = 6). The liver-first approach was associated with shorter recurrence-free survival (median 12 versus 23 months, p = 0.004), driven by extrahepatic recurrence-free survival (3-year: 20% versus 55%, p = 0.04). Overall survival was not significantly different at 3-years (79% versus 80%, p = 0.95) or 5-years (59% versus 59%, p > 0.99). LIMITATIONS This study has a retrospective design and limited sample size. CONCLUSIONS A liver-first approach is associated with worse recurrence free-survival compared to primary-first or simultaneous resection, driven by extrahepatic recurrence. Prospective study of whether oncologic risk is associated with leaving the primary in situ is needed. Multidisciplinary treatment sequencing and enhanced postoperative surveillance for patients receiving liver-first resection is recommended. See Video Abstract.
同步性结直肠癌肝转移患者先切肝与较差的无复发生存率有关:重新考虑原发癌的重要性。
背景同步性结直肠肝转移可采用原发灶先切除、同时切除或肝脏先切除术。本研究旨在评估同步性结直肠肝转移患者在三种治疗策略中的肿瘤生存率,以及原发肿瘤的早期或延迟切除。主要结局指标总生存期和无复发生存期。结果在151名患者中,23%(n=35)采用肝脏先露术,77%(n=116;原发先露=93,同期=23)采用原发先露/同期术。中位随访时间为45个月。肝脏先露组与原发先露/同期组相比,无复发生存期更短(中位 12 个月对 16 个月,P = 0.02),肝脏先露组、原发先露组和同期组的三年肝外无复发生存期分别为 19%、58% 和 50%。三年总生存率分别为86%、79%和86%,无明显差异。原发第一组和同时发生组的肿瘤学结果无明显差异(均 p > 0.4)。匹配结果显示,每组有34名临床病理相似的患者(肝脏在先=34,原发在先=28/同期=6)。在肝外无复发生存期(3 年:20% 对 55%,P = 0.04)的推动下,肝脏先入路与较短的无复发生存期(中位 12 个月对 23 个月,P = 0.004)相关。本研究采用回顾性设计,样本量有限。结论与原发灶先切除术或同时切除术相比,肝脏先切除术的无复发生存率更低,其原因在于肝外复发。需要对原发灶留在原位是否会带来肿瘤风险进行前瞻性研究。建议对接受先肝切除术的患者进行多学科治疗排序并加强术后监测。参见视频摘要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.50
自引率
7.70%
发文量
572
审稿时长
3-8 weeks
期刊介绍: Diseases of the Colon & Rectum (DCR) is the official journal of the American Society of Colon and Rectal Surgeons (ASCRS) dedicated to advancing the knowledge of intestinal disorders by providing a forum for communication amongst their members. The journal features timely editorials, original contributions and technical notes.
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