Primary Tumor Versus Liver-First Approach for Synchronous Colorectal Liver Metastases: An Association Française de Chirurgie (AFC) Multicenter-Based Study with Propensity Score Analysis
Francesco Esposito
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Université Paris-Est (UPEC), 51 Avenue de Lattre de Tassigny, 94010 Créteil, France
Search for more papers by this authorChetana Lim
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Université Paris-Est (UPEC), 51 Avenue de Lattre de Tassigny, 94010 Créteil, France
Search for more papers by this authorAntonio Sa Cunha
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France
Search for more papers by this authorPatrick Pessaux
Institut Hospitalo-Universitaire, Institute for Minimally Hybrid Invasive Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
Institut de Recherche sur les Cancers de l’Appareil Digestif (IRCAD), Strasbourg, France
Search for more papers by this authorFrancis Navarro
Department of Surgery, Saint-Eloi Hospital, Université de Montpellier, Montpellier, France
Search for more papers by this authorCorresponding Author
Daniel Azoulay
- [email protected]
- + 33 1 49 81 25 48
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Université Paris-Est (UPEC), 51 Avenue de Lattre de Tassigny, 94010 Créteil, France
INSERM, U955, Créteil, France
Tel.: + 33 1 49 81 25 48, [email protected]Search for more papers by this authorFrench Colorectal Liver Metastases Working Group, Association Française de Chirurgie (AFC)
Search for more papers by this authorCyril Cosse
Search for more papers by this authorDelphine Lignier
Search for more papers by this authorJean Marc Regimbeau
Search for more papers by this authorJulien Barbieux
Search for more papers by this authorEmilie Lermite
Search for more papers by this authorAntoine Hamy
Search for more papers by this authorFrançois Mauvais
Search for more papers by this authorChristophe Laurent
Search for more papers by this authorIrchid Al Naasan
Search for more papers by this authorDaniel Azoulay
Search for more papers by this authorChady Salloum
Search for more papers by this authorPhilippe Compagnon
Search for more papers by this authorChetana Lim
Search for more papers by this authorMohammed Sbai Idrissi
Search for more papers by this authorFréderic Martin
Search for more papers by this authorJerôme Atger
Search for more papers by this authorJacques Baulieux
Search for more papers by this authorBenjamin Darnis
Search for more papers by this authorJean Yves Mabrut
Search for more papers by this authorVahan Kepenekian
Search for more papers by this authorJulie Perinel
Search for more papers by this authorMustapha Adham
Search for more papers by this authorOlivier Glehen
Search for more papers by this authorMichel Rivoire
Search for more papers by this authorJean Hardwigsen
Search for more papers by this authorAnais Palen
Search for more papers by this authorEmilie Grégoire
Search for more papers by this authorYves Patrice LeTreut
Search for more papers by this authorJean Robert Delpero
Search for more papers by this authorOlivier Turrini
Search for more papers by this authorAstrid Herrero
Search for more papers by this authorFrancis Navarro
Search for more papers by this authorFabrizio Panaro
Search for more papers by this authorAhmet Ayav
Search for more papers by this authorLaurent Bresler
Search for more papers by this authorPhilippe Rauch
Search for more papers by this authorFrançois Guillemin
Search for more papers by this authorFréderic Marchal
Search for more papers by this authorJean Gugenheim
Search for more papers by this authorAntonio Iannelli
Search for more papers by this authorStephane Benoist
Search for more papers by this authorAntoine Brouquet
Search for more papers by this authorMarc Pocard
Search for more papers by this authorRéa Lo Dico
Search for more papers by this authorBrice Gayet
Search for more papers by this authorDavid Fuks
Search for more papers by this authorOlivier Scatton
Search for more papers by this authorOlivier Soubrane
Search for more papers by this authorJean-Christophe Vaillant
Search for more papers by this authorTullio Piardi
Search for more papers by this authorDaniel Sommacale
Search for more papers by this authorReza Kianmanesh
Search for more papers by this authorMichel Comy
Search for more papers by this authorPhilippe Bachellier
Search for more papers by this authorElie Oussoultzoglou
Search for more papers by this authorPietro Addeo
Search for more papers by this authorDimitrios Ntourakis
Search for more papers by this authorPatrick Pessaux
Search for more papers by this authorDidier Mutter
Search for more papers by this authorJacques Marescaux
Search for more papers by this authorLoïc Raoux
Search for more papers by this authorBertrand Suc
Search for more papers by this authorFabrice Muscari
Search for more papers by this authorGeorges Elhomsy
Search for more papers by this authorMaximiliano Gelli
Search for more papers by this authorAntonio Sa Cunha
Search for more papers by this authorDenis Castaing
Search for more papers by this authorDaniel Cherqui
Search for more papers by this authorGabriella Pittau
Search for more papers by this authorOriana Ciacio
Search for more papers by this authorEric Vibert
Search for more papers by this authorDominique Elias
Search for more papers by this authorDiane Goére
Search for more papers by this authorFabrizio Vittadello
Search for more papers by this authorFrancesco Esposito
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Université Paris-Est (UPEC), 51 Avenue de Lattre de Tassigny, 94010 Créteil, France
Search for more papers by this authorChetana Lim
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Université Paris-Est (UPEC), 51 Avenue de Lattre de Tassigny, 94010 Créteil, France
Search for more papers by this authorAntonio Sa Cunha
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France
Search for more papers by this authorPatrick Pessaux
Institut Hospitalo-Universitaire, Institute for Minimally Hybrid Invasive Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
Institut de Recherche sur les Cancers de l’Appareil Digestif (IRCAD), Strasbourg, France
Search for more papers by this authorFrancis Navarro
Department of Surgery, Saint-Eloi Hospital, Université de Montpellier, Montpellier, France
Search for more papers by this authorCorresponding Author
Daniel Azoulay
- [email protected]
- + 33 1 49 81 25 48
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Université Paris-Est (UPEC), 51 Avenue de Lattre de Tassigny, 94010 Créteil, France
INSERM, U955, Créteil, France
Tel.: + 33 1 49 81 25 48, [email protected]Search for more papers by this authorFrench Colorectal Liver Metastases Working Group, Association Française de Chirurgie (AFC)
Search for more papers by this authorCyril Cosse
Search for more papers by this authorDelphine Lignier
Search for more papers by this authorJean Marc Regimbeau
Search for more papers by this authorJulien Barbieux
Search for more papers by this authorEmilie Lermite
Search for more papers by this authorAntoine Hamy
Search for more papers by this authorFrançois Mauvais
Search for more papers by this authorChristophe Laurent
Search for more papers by this authorIrchid Al Naasan
Search for more papers by this authorDaniel Azoulay
Search for more papers by this authorChady Salloum
Search for more papers by this authorPhilippe Compagnon
Search for more papers by this authorChetana Lim
Search for more papers by this authorMohammed Sbai Idrissi
Search for more papers by this authorFréderic Martin
Search for more papers by this authorJerôme Atger
Search for more papers by this authorJacques Baulieux
Search for more papers by this authorBenjamin Darnis
Search for more papers by this authorJean Yves Mabrut
Search for more papers by this authorVahan Kepenekian
Search for more papers by this authorJulie Perinel
Search for more papers by this authorMustapha Adham
Search for more papers by this authorOlivier Glehen
Search for more papers by this authorMichel Rivoire
Search for more papers by this authorJean Hardwigsen
Search for more papers by this authorAnais Palen
Search for more papers by this authorEmilie Grégoire
Search for more papers by this authorYves Patrice LeTreut
Search for more papers by this authorJean Robert Delpero
Search for more papers by this authorOlivier Turrini
Search for more papers by this authorAstrid Herrero
Search for more papers by this authorFrancis Navarro
Search for more papers by this authorFabrizio Panaro
Search for more papers by this authorAhmet Ayav
Search for more papers by this authorLaurent Bresler
Search for more papers by this authorPhilippe Rauch
Search for more papers by this authorFrançois Guillemin
Search for more papers by this authorFréderic Marchal
Search for more papers by this authorJean Gugenheim
Search for more papers by this authorAntonio Iannelli
Search for more papers by this authorStephane Benoist
Search for more papers by this authorAntoine Brouquet
Search for more papers by this authorMarc Pocard
Search for more papers by this authorRéa Lo Dico
Search for more papers by this authorBrice Gayet
Search for more papers by this authorDavid Fuks
Search for more papers by this authorOlivier Scatton
Search for more papers by this authorOlivier Soubrane
Search for more papers by this authorJean-Christophe Vaillant
Search for more papers by this authorTullio Piardi
Search for more papers by this authorDaniel Sommacale
Search for more papers by this authorReza Kianmanesh
Search for more papers by this authorMichel Comy
Search for more papers by this authorPhilippe Bachellier
Search for more papers by this authorElie Oussoultzoglou
Search for more papers by this authorPietro Addeo
Search for more papers by this authorDimitrios Ntourakis
Search for more papers by this authorPatrick Pessaux
Search for more papers by this authorDidier Mutter
Search for more papers by this authorJacques Marescaux
Search for more papers by this authorLoïc Raoux
Search for more papers by this authorBertrand Suc
Search for more papers by this authorFabrice Muscari
Search for more papers by this authorGeorges Elhomsy
Search for more papers by this authorMaximiliano Gelli
Search for more papers by this authorAntonio Sa Cunha
Search for more papers by this authorDenis Castaing
Search for more papers by this authorDaniel Cherqui
Search for more papers by this authorGabriella Pittau
Search for more papers by this authorOriana Ciacio
Search for more papers by this authorEric Vibert
Search for more papers by this authorDominique Elias
Search for more papers by this authorDiane Goére
Search for more papers by this authorFabrizio Vittadello
Search for more papers by this authorFrancesco Esposito and Chetana Lim are co-first authors.
Members of the French Colorectal Liver Metastases Working Group are co-authors of this study and can be found in the Acknowledgements section.
Electronic supplementary material: The online version of this article (https://doi.org/10.1007/s00268-018-4711-x) contains supplementary material, which is available to authorized users.
Abstract
Objectives
Multicenter studies comparing the reverse strategy (RS) with the classical strategy (CS) for the management of stage IVA liver-only colorectal cancer (CCR) are scarce. The aim of this study was to compare long-term survival and recurrence patterns following use of the CS and RS.
Method
This retrospective multicenter review collected data from all consecutive patients with stage IVA liver-only CCR who underwent staged resection of CCR and liver metastases (LM) at 24 French hospitals between 2006 and 2013 and were retrospectively analyzed. Patients who underwent simultaneous liver and CCR resection, those with synchronous extrahepatic metastasis, and those who underwent emergent CCR resection were excluded. Overall survival (OS) and recurrence-free survival (RFS) rates and recurrence patterns were investigated before and after propensity score matching (PSM).
Results
A total of 653 patients were included: 587 (89.9%) in the CS group and 66 (10.1%) in the RS group. Compared with the CS patients, RS patients were more likely to have rectal cancer (43.9 vs. 24.9%; p = 0.006), larger liver tumor size (52.5 ± 38.6 vs. 39.6 ± 30 mm; p = 0.01), and more positive lymph nodes (62.1 vs. 44.8%; p = 0.009). OS was not different between the two groups (75 vs. 72% at 5 years; p = 0.77), while RFS was worse in the RS group (24 vs. 33% at 5 years; p = 0.01). Time to recurrence at any site (1.8 vs. 2.4 years, p = 0.024) and intrahepatic recurrence (1.7 vs. 2.2 years, p = 0.014) were significantly shorter in the RS group than in the CS group. After PSM (63 patients in each group), no significant difference was found between the two groups in OS (p = 0.35), RFS (p = 0.62), time to recurrence at any site (p = 0.19), or intrahepatic recurrence (p = 0.13).
Conclusions
In this study, approximately 10% of patients with CCR and synchronous LM were offered surgery with the RS. Both strategies ensured similar oncological outcomes.
Supporting Information
| Filename | Description |
|---|---|
| wjsbf09093-sup-0001.docxapplication/docx, 21.5 KB | Supplementary material 1 (DOCX 21 kb) |
| wjsbf09093-sup-0002.docxapplication/docx, 16.1 KB | Supplementary material 2 (DOCX 16 kb) |
| wjsbf09093-sup-0003.docxapplication/docx, 14.3 KB | Supplementary material 3 (DOCX 14 kb) |
| wjsbf09093-sup-0004.docxapplication/docx, 17.3 KB | Supplementary material 4 (DOCX 17 kb) |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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