Skip to main content
SpringerLink
Log in

Primary Tumor Versus Liver-First Approach for Synchronous Colorectal Liver Metastases: An Association Française de Chirurgie (AFC) Multicenter-Based Study with Propensity Score Analysis

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mentha G, Majno PE, Andres A, Rubbia-Brandt L, Morel P, Roth AD (2006) Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg 93(7):872–878

    Article  CAS  Google Scholar 

  2. Feng Q, Wei Y, Zhu D et al (2014) Timing of hepatectomy for resectable synchronous colorectal liver metastases: for whom simultaneous resection is more suitable—a meta-analysis. PLoS ONE 9(8):e104348

    Article  Google Scholar 

  3. Slesser AA, Chand M, Goldin R, Brown G, Tekkis PP, Mudan S (2013) Outcomes of simultaneous resections for patients with synchronous colorectal liver metastases. Eur J Surg Oncol 39(12):1384–1393

    Article  CAS  Google Scholar 

  4. Reddy SK, Pawlik TM, Zorzi D et al (2007) Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol 14(12):3481–3491

    Article  Google Scholar 

  5. Lim C, Doussot A, Osseis M et al (2016) Primary tumor versus liver-first strategy in patients with stage IVA colorectal cancer: a propensity score analysis of long-term outcomes and recurrence pattern. Ann Surg Oncol 23(9):3024–3032

    Article  Google Scholar 

  6. Tanaka K, Murakami T, Matsuo K et al (2015) Preliminary results of ‘liver-first’ reverse management for advanced and aggressive synchronous colorectal liver metastases: a propensity-matched analysis. Dig Surg 32(1):16–22

    Article  Google Scholar 

  7. Allard MA, Cunha AS, Gayet B et al (2015) Early and long-term oncological outcomes after laparoscopic resection for colorectal liver metastases: a propensity score-based analysis. Ann Surg 262(5):794–802

    Article  Google Scholar 

  8. Memeo R, de Blasi V, Adam R et al (2016) Parenchymal-sparing hepatectomies (PSH) for bilobar colorectal liver metastases are associated with a lower morbidity and similar oncological results: a propensity score matching analysis. HPB (Oxford) 18(9):781–790

    Article  Google Scholar 

  9. Hallet J, Cunha AS, Adam R et al (2016) Outcomes of rehepatectomy for colorectal liver metastases: a contemporary multi-institutional analysis from the French surgical association database. Ann Surg Oncol 23(Suppl 5):894–903

    Article  Google Scholar 

  10. Memeo R, de Blasi V, Adam R et al (2017) Margin status is still an important prognostic factor in hepatectomies for colorectal liver metastases: a propensity score matching analysis. World J Surg. https://doi.org/10.1007/s00268-017-4229-7

    Article  Google Scholar 

  11. Hallet J, Cunha AS, Adam R et al (2016) Factors influencing recurrence following initial hepatectomy for colorectal liver metastases. Br J Surg 103(10):1366–1376

    Article  CAS  Google Scholar 

  12. Van Cutsem E, Nordlinger B, Adam R et al (2006) Towards a pan-European consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer 42(14):2212–2221

    Article  Google Scholar 

  13. Benchimol EI, Langan S, Guttmann A, Committee RS (2013) Call to RECORD: the need for complete reporting of research using routinely collected health data. J Clin Epidemiol 66(7):703–705

    Article  Google Scholar 

  14. Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46(3):399–424

    Article  Google Scholar 

  15. Valdimarsson VT, Syk I, Lindell G et al (2017) Outcomes of liver-first strategy and classical strategy for synchronous colorectal liver metastases in Sweden. HPB (Oxford) 20:441–447

    Article  Google Scholar 

  16. Welsh FK, Chandrakumaran K, John TG, Cresswell AB, Rees M (2016) Propensity score-matched outcomes analysis of the liver-first approach for synchronous colorectal liver metastases. Br J Surg 103(5):600–606

    Article  CAS  Google Scholar 

  17. Brouquet A, Mortenson MM, Vauthey JN et al (2010) Surgical strategies for synchronous colorectal liver metastases in 156 consecutive patients: classic, combined or reverse strategy? J Am Coll Surg 210(6):934–941

    Article  Google Scholar 

  18. Sturesson C, Valdimarsson VT, Blomstrand E et al (2017) Liver-first strategy for synchronous colorectal liver metastases—an intention-to-treat analysis. HPB (Oxford) 19(1):52–58

    Article  Google Scholar 

  19. Hallet J, Cunha AS, Adam R et al (2016) Factors influencing recurrence following initial hepatectomy for colorectal liver metastases. Br J Surg 103(10):1366–1376

    Article  CAS  Google Scholar 

  20. Hallet J, Cunha AS, Adam R et al (2016) Outcomes of rehepatectomy for colorectal liver metastases. A contemporary multi-institutional analysis from the French surgical association database. Ann Surg Oncol 23:894–903

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all participating centers for their contribution to this study.

Contributors: Amiens, CHU Amiens Picardie: Cyril Cosse, Delphine Lignier, Jean Marc Regimbeau; Angers, CHU Angers: Julien Barbieux, Emilie Lermite, Antoine Hamy; Beauvais, CH Beauvais: François Mauvais; Bordeaux, Groupe Hospitalier Saint André: Christophe Laurent; Chambery, CH Chambery: Irchid Al Naasan; Créteil, CHU Henri Mondor: Daniel Azoulay, Chady Salloum, Philippe Compagnon, Chetana Lim; Eaubonne, Hôpital Simone Veil: Mohammed Sbai Idrissi; Epinal, Polyclinique de la Ligne Bleue: Fréderic Martin; Gap, CH des Alpes du Sud: Jerôme Atger; Lyon, Hôpital de la Croix Rousse: Jacques Baulieux, Benjamin Darnis, Jean Yves; Mabrut; Lyon, Hôpital Edouart-Herriot: Vahan Kepenekian, Julie Perinel, Mustapha Adham; Lyon, CH Lyon Sud: Olivier Glehen; Lyon, Centre Léon Bérard: Michel Rivoire; Marseille, Hôpital de la Conception: Jean Hardwigsen, Anais Palen, Emilie Grégoire, Yves Patrice LeTreut; Marseille, Institut Paoli-Calmettes: Jean Robert Delpero, Olivier Turrini; Montpellier, Hôpital Saint Eloi: Astrid Herrero, Francis Navarro, Fabrizio Panaro; Nancy, CHU Brabois: Ahmet Ayav, Laurent Bresler; Nancy, Institut de Cancérologie de Lorraine Alexis-Vautrin: Philippe Rauch, François; Guillemin, Fréderic Marchal; Nice, Hôpital de l’Archet: Jean Gugenheim, Antonio Iannelli; Kremlin Bicêtre, CHU Kremlin Bicêtre: Stephane Benoist, Antoine Brouquet; Paris, Hôpital Lariboisière: Marc Pocard, Réa Lo Dico; Paris, Institut Mutualiste Montsouris: Brice Gayet, David Fuks; Paris, Hôpital Saint Antoine: Olivier. Scatton, Olivier Soubrane; Paris, Hôpital de la Pitié Salpetrière: Jean-Christophe Vaillant; Reims, Hôpital Robert Debré: Tullio Piardi, Daniel Sommacale, Reza Kianmanesh; La Roche-sur-Yon, Centre départemental de Vendée: Michel Comy; Strasbourg, Hôpital Hautepierre: Philippe Bachellier, Elie Oussoultzoglou, Pietro Addeo; Strasbourg, Nouvel Hôpital Civil: Dimitrios Ntourakis, Patrick Pessaux, Didier Mutter, Jacques Marescaux; Toulouse, Hôpital Rangueil: Loïc Raoux, Bertrand Suc, Fabrice Muscari; Troyes, Hôpital des Hauts-Clos: Georges Elhomsy; Villejuif, Hôpital Paul Brousse: Maximiliano Gelli, Antonio Sa Cunha, René Adam, Denis Castaing, Daniel Cherqui; Gabriella Pittau, Oriana Ciacio, Eric Vibert; and Villejuif, Gustave Roussy: Dominique Elias, Diane Goére, Fabrizio Vittadello.

Author information

Author notes

  1. Francesco Esposito and Chetana Lim are co-first authors.

Authors and Affiliations

  1. 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

    Francesco Esposito, Chetana Lim & Daniel Azoulay

  2. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France

    Antonio Sa Cunha

  3. Institut Hospitalo-Universitaire, Institute for Minimally Hybrid Invasive Image-Guided Surgery, Université de Strasbourg, Strasbourg, France

    Patrick Pessaux

  4. Institut de Recherche sur les Cancers de l’Appareil Digestif (IRCAD), Strasbourg, France

    Patrick Pessaux

  5. Department of Surgery, Saint-Eloi Hospital, Université de Montpellier, Montpellier, France

    Francis Navarro

  6. INSERM, U955, Créteil, France

    Daniel Azoulay

Authors
  1. Francesco Esposito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chetana Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antonio Sa Cunha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patrick Pessaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francis Navarro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel Azoulay
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

On behalf of the French Colorectal Liver Metastases Working Group, Association Française de Chirurgie (AFC)

  • Cyril Cosse
  • , Delphine Lignier
  • , Jean Marc Regimbeau
  • , Julien Barbieux
  • , Emilie Lermite
  • , Antoine Hamy
  • , François Mauvais
  • , Christophe Laurent
  • , Irchid Al Naasan
  • , Daniel Azoulay
  • , Chady Salloum
  • , Philippe Compagnon
  • , Chetana Lim
  • , Mohammed Sbai Idrissi
  • , Fréderic Martin
  • , Jerôme Atger
  • , Jacques Baulieux
  • , Benjamin Darnis
  • , Jean Yves Mabrut
  • , Vahan Kepenekian
  • , Julie Perinel
  • , Mustapha Adham
  • , Olivier Glehen
  • , Michel Rivoire
  • , Jean Hardwigsen
  • , Anais Palen
  • , Emilie Grégoire
  • , Yves Patrice LeTreut
  • , Jean Robert Delpero
  • , Olivier Turrini
  • , Astrid Herrero
  • , Francis Navarro
  • , Fabrizio Panaro
  • , Ahmet Ayav
  • , Laurent Bresler
  • , Philippe Rauch
  • , François Guillemin
  • , Fréderic Marchal
  • , Jean Gugenheim
  • , Antonio Iannelli
  • , Stephane Benoist
  • , Antoine Brouquet
  • , Marc Pocard
  • , Réa Lo Dico
  • , Brice Gayet
  • , David Fuks
  • , Olivier Scatton
  • , Olivier Soubrane
  • , Jean-Christophe Vaillant
  • , Tullio Piardi
  • , Daniel Sommacale
  • , Reza Kianmanesh
  • , Michel Comy
  • , Philippe Bachellier
  • , Elie Oussoultzoglou
  • , Pietro Addeo
  • , Dimitrios Ntourakis
  • , Patrick Pessaux
  • , Didier Mutter
  • , Jacques Marescaux
  • , Loïc Raoux
  • , Bertrand Suc
  • , Fabrice Muscari
  • , Georges Elhomsy
  • , Maximiliano Gelli
  • , Antonio Sa Cunha
  • , René Adam
  • , Denis Castaing
  • , Daniel Cherqui
  • , Gabriella Pittau
  • , Oriana Ciacio
  • , Eric Vibert
  • , Dominique Elias
  • , Diane Goére
  •  & Fabrizio Vittadello

Contributions

Esposito, Lim, and Azoulay contributed to the study concept and design and statistical analysis. All authors involved in acquisition, analysis, and interpretation of data. Esposito, Lim, and Azoulay drafted the manuscript. Lim, Azoulay, Sa Cunha, Navarro, and Pessaux critically revised the manuscript for important intellectual content. Navarro, Sa Cunha, and Pessaux provided administrative, technical, and material support. Lim and Azoulay supervised the study.

Corresponding author

Correspondence to Daniel Azoulay.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Esposito, F., Lim, C., Sa Cunha, A. et al. Primary Tumor Versus Liver-First Approach for Synchronous Colorectal Liver Metastases: An Association Française de Chirurgie (AFC) Multicenter-Based Study with Propensity Score Analysis. World J Surg 42, 4046–4053 (2018). https://doi.org/10.1007/s00268-018-4711-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-018-4711-x

Search

Navigation