"Liver-first" approach for synchronous colorectal liver metastases: is this a justifiable approach?
ABSTRACT BACKGROUND: To review the outcomes of patients with synchronous colorectal liver metastases (CRLM) treated by the "liver-first" approach. METHODS: Relevant articles were reviewed from the published literature using the Medline database. The search was performed using the keywords "colorectal cancer", "liver-first", "reverse strategy", "liver metastases", "liver resection" and "hepatectomy". RESULTS: There have been four retrospective studies that have reported the outcomes of patients with synchronous CRLM following the reverse strategy. The number of patients included ranged from 16 to 27. One study included patients with advanced rectal cancer and synchronous liver metastases only. None of the studies defined resectability for the CRLM. Overall, the morbidity and mortality rates were low. The recurrence rate ranged from 25 to 70 %. One study did not report survival data, and the overall 5 year survival ranged from 31 to 41 %. CONCLUSION: The "liver-first" approach may be beneficial to a selected group of patients with synchronous CRLM. Patient selection is likely to be determined by their response to down-staging chemotherapy with or without biological agents.
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ABSTRACT: The presence of liver metastases in a patient with colorectal cancer decreases the expected 5 year survival rates by a factor close to nine. It is generally accepted that resection of liver metastases should be attempted whenever feasible. This systematic review addresses the optimal therapeutic plan regarding timing of resection of synchronous liver metastases and the use of chemotherapy in combination with resection of synchronous metachronous liver metastases. The aim of the review is to pool all published results in order to attribute a level of evidence to outcomes and to identify areas where evidence is lacking. A systematic search of guidelines (9/2012), reviews (2/2009-1/2013), randomized controlled and observational studies (1/2010-1/2013) yielded 5 guidelines, 7 systematic reviews, 1 randomized controlled trial and 1 retrospective study. Data were extracted and analysed including updating a meta-analysis. The data failed to demonstrate an effect of timing of surgery or use of chemotherapy on overall survival. Concomitant resection of liver metastases and the primary tumour may result in lower postoperative morbidity. Systemic peri-operative chemotherapy may improve progression free survival compared to surgery alone.Critical Reviews in Oncology/Hematology 01/2015; 94(1). DOI:10.1016/j.critrevonc.2014.12.004 · 4.05 Impact Factor
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ABSTRACT: Timing and sequence of therapeutic interventions in patients with colorectal cancer (CRC) and synchronous liver metastases is a matter of ongoing discussion. The aim of this report is to show the feasibility and safety of a reversed strategy in patients with up front resectable synchronous liver metastases. Consecutive series of 15 patients with locally advanced rectal carcinoma and liver synchronous metastases where up front liver resection was carried out as an initial intervention is presented. Local treatment of both, metastatic disease and primary tumor, was preferred. Liver resection was followed by neoadjuvant (preoperative) concomitant radiochemotherapy (RCT) for local pelvic disease control and subsequent resection of rectum. Systemic adjuvant chemotherapy was placed at the end of the entire treatment cycle. All 15 patients after up front hepatectomy were able to proceed with their treatment plan. 14 patients completed their RCT for primary tumor and subsequent rectal resection was successfully carried out. In 12 of them. 3 patients showed complete clinical response on cross sectional imaging and a careful "wait-and-see" policy was adopted for them. In two patients metastatic disease progression was noticed during the treatment cycle.Liver first approach in patients with up front resectable colorectal liver metastases (CRLM) is safe and feasible. Local neoadjuvant treatment after CRLM resection may result in preoperative downsizing or even complete clinical response of the primary tumor. Reversed strategy may to a degree eliminate negative oncologic impact of surgical complications after rectal surgery as CRLM has been already addressed. Keywords: hepatectomy, liver first approach, reversed strategy, synchronous liver metastases.Neoplasma 03/2014; 61(4). DOI:10.4149/neo_2014_055 · 1.64 Impact Factor
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ABSTRACT: Abstract Although simultaneous resection of primary colorectal cancer and synchronous liver metastases is reported to be safe and effective, the feasibility of a laparoscopic approach remains controversial. This study evaluated the safety, feasibility, and short-term outcomes of simultaneous laparoscopic surgery for primary colorectal cancer with synchronous liver metastases. From September 2008 to December 2013, 10 patients underwent simultaneous laparoscopic resection of primary colorectal cancer and synchronous liver metastases with curative intent at our institute. The median operative time was 452 minutes, and the median estimated blood loss was 245 mL. Median times to discharge from the hospital and adjuvant chemotherapy were 13.5 and 44 postoperative days, respectively. Negative resection margins were achieved in all cases, with no postoperative mortality or major morbidity. Simultaneous laparoscopic colectomy and hepatectomy for primary colorectal cancer with synchronous liver metastases appears feasible with low morbidity and favorable outcomes.International surgery 07/2014; 99(4):338-343. DOI:10.9738/INTSURG-D-14-00019.1 · 0.25 Impact Factor