Skip to main content

Advertisement

SpringerLink
Log in

Predicting Limited Survival After Resection of Synchronous Colorectal Liver Metastases: a Propensity Score Matched Comparison Between The Primary First And The Simultaneous Strategy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The best surgical approach to treat synchronous colorectal liver metastases (CRLM) remains unclear. Here, we aimed to identify prognostic factors associated with limited survival comparing patients undergoing primary-first resection (PF) and simultaneous resection (SR) approaches.

Methods

We retrospectively reviewed clinical data of 217 patients who underwent resection for synchronous CRLMs between January 1, 2011, and December 31, 2021. There were 133 (61.2%) PF resection and 84 (38.8%) SRS. The two groups of patients were compared using propensity score matching (PSM) analysis and cox analysis was performed to identify prognostic factors for overall survival (OS).

Results

After PSM, two groups of 71 patients were compared. Patients undergoing SR had longer operative time (324 ± 104 min vs 250 ± 101 min; p < 0.0001), similar transfusion (33.3% vs 28.1%; p = 0.57), and similar complication rates (35.9% vs 27.2%; p = 0.34) than patients undergoing PF. The median overall survival and 5-year survival rates were comparable (p = 0.94) between patients undergoing PF (48.2 months and 44%) and patients undergoing SR (45.9 months and 30%). Multivariate Cox analysis identified pre-resection elevated CEA levels (HR: 2.38; 95% CI: 1.20–4.70; P = .01), left colonic tumors (HR: 0.34; 95% CI: 0.17–0.68; P = .002), and adjuvant treatment (HR: 0.43; 95% CI: 0.22–0.83; P = .01) as independent prognostic factors for OS.

Conclusions

In the presence of synchronous CRLM, right colonic tumors, persistent high CEA levels before surgery, and the absence of adjuvant treatment identified patients characterized by a limited survival rate after resection. The approach used (PF vs SR) does not influence short and long-term 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

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

References

  1. Engstrand J, Nilsson H, Stromberg C, Jonas E, Freedman J. Colorectal cancer liver metastases - a population-based study on incidence, management and survival. BMC Cancer 2018;18:78.

    Article  PubMed  PubMed Central  Google Scholar 

  2. McMillan DC, McArdle CS. Epidemiology of colorectal liver metastases. Surg Oncol 2007;16:3-5.

    Article  PubMed  Google Scholar 

  3. Boudjema K, Locher C, Sabbagh C, et al. Simultaneous Versus Delayed Resection for Initially Resectable Synchronous Colorectal Cancer Liver Metastases: A Prospective, Open-label, Randomized, Controlled Trial. Ann Surg 2021;273:49-56.

    PubMed  Google Scholar 

  4. Gavriilidis P, Sutcliffe RP, Hodson J, et al. Simultaneous versus delayed hepatectomy for synchronous colorectal liver metastases: a systematic review and meta-analysis. HPB (Oxford) 2018;20:11-9.

    Article  PubMed  Google Scholar 

  5. Hajibandeh S, Hajibandeh S, Sultana A, et al. Simultaneous versus staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases: a meta-analysis of outcomes and clinical characteristics. Int J Colorectal Dis 2020;35:1629-50.

    Article  PubMed  Google Scholar 

  6. Weber JC, Bachellier P, Oussoultzoglou E, Jaeck D. Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg 2003;90:956-62.

    Article  CAS  PubMed  Google Scholar 

  7. Giuliante F, Vigano L, De Rose AM, et al. Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry. Ann Surg Oncol 2021;28:8198-208.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Esposito F, Lim C, Sa Cunha A, et al. Primary Tumor Versus Liver-First Approach for Synchronous Colorectal Liver Metastases: An Association Francaise de Chirurgie (AFC) Multicenter-Based Study with Propensity Score Analysis. World J Surg 2018;42:4046-53.

    Article  PubMed  Google Scholar 

  9. Lim C, Doussot A, Osseis M, et al. 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 2016;23:3024-32.

    Article  PubMed  Google Scholar 

  10. Torzilli G, Procopio F, Botea F, et al. One-stage ultrasonographically guided hepatectomy for multiple bilobar colorectal metastases: a feasible and effective alternative to the 2-stage approach. Surgery 2009;146:60-71.

    Article  PubMed  Google Scholar 

  11. Faitot F, Faron M, Adam R, et al. Two-stage hepatectomy versus 1-stage resection combined with radiofrequency for bilobar colorectal metastases: a case-matched analysis of surgical and oncological outcomes. Ann Surg 2014;260:822-7; discussion 7-8.

    Article  PubMed  Google Scholar 

  12. Karoui M, Vigano L, Goyer P, et al. Combined first-stage hepatectomy and colorectal resection in a two-stage hepatectomy strategy for bilobar synchronous liver metastases. Br J Surg 2010;97:1354-62.

    Article  CAS  PubMed  Google Scholar 

  13. Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 2005;12:351-5.

    Article  PubMed  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Balzan S, Belghiti J, Farges O, et al. The “50-50 criteria” on post-operative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 2005;242:824-8, discussion 8-9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rahbari NN, Garden OJ, Padbury R, et al. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford) 2011;13:528-35.

    Article  PubMed  Google Scholar 

  17. Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 2011;149:680-8.

    Article  PubMed  Google Scholar 

  18. Rahbari NN, Garden OJ, Padbury R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 2011;149:713-24.

    Article  PubMed  Google Scholar 

  19. Elias D, Detroz B, Lasser P, Plaud B, Jerbi G. Is simultaneous hepatectomy and intestinal anastomosis safe? Am J Surg 1995;169:254-60.

    Article  CAS  PubMed  Google Scholar 

  20. Snyder RA, Hao S, Irish W, Zervos EE, Tuttle-Newhall JE, Parikh AA. Thirty-Day Morbidity after Simultaneous Resection of Colorectal Cancer and Colorectal Liver Metastasis: American College of Surgeons NSQIP Analysis. J Am Coll Surg 2020;230:617-27 e9.

    Article  PubMed  Google Scholar 

  21. Guerra F, Petrelli F, Greco PA, et al. The impact of synchronous liver resection on the risk of anastomotic leakage following elective colorectal resection. A propensity score match analysis on behalf of the iCral study group. Eur J Surg Oncol 2021;47:2873-9.

    Article  PubMed  Google Scholar 

  22. Driedger MR, Yamashita TS, Starlinger P, et al. Synchronous resection of colorectal cancer primary and liver metastases: an outcomes analysis. HPB (Oxford) 2021;23:1277-84.

    Article  PubMed  Google Scholar 

  23. Mitry E, Fields AL, Bleiberg H, et al. Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials. J Clin Oncol 2008;26:4906-11.

    Article  CAS  PubMed  Google Scholar 

  24. Parks R, Gonen M, Kemeny N, et al. Adjuvant chemotherapy improves survival after resection of hepatic colorectal metastases: analysis of data from two continents. J Am Coll Surg 2007;204:753-61; discussion 61-3.

    Article  PubMed  Google Scholar 

  25. Araujo RL, Gonen M, Herman P. Chemotherapy for patients with colorectal liver metastases who underwent curative resection improves long-term outcomes: systematic review and meta-analysis. Ann Surg Oncol 2015;22:3070-8.

    Article  PubMed  Google Scholar 

  26. Di Martino M, Primavesi F, Syn N, et al. Perioperative chemotherapy versus surgery alone for resectable colorectal liver metastases: an international multicentre propensity score matched analysis on long-term outcomes according to established prognostic risk scores. HPB (Oxford) 2021;23:1873-85.

    Article  PubMed  Google Scholar 

  27. Sasaki K, Margonis GA, Andreatos N, et al. Pre-hepatectomy carcinoembryonic antigen (CEA) levels among patients undergoing resection of colorectal liver metastases: do CEA levels still have prognostic implications? HPB (Oxford) 2016;18:1000-9.

    Article  PubMed  Google Scholar 

  28. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999;230:309-18; discussion 18-21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Wang XY, Zhang R, Wang Z et al Meta-analysis of the association between primary tumour location and prognosis after surgical resection of colorectal liver metastases. Br J Surg 2019 Dec;106(13):1747-1760. https://doi.org/10.1002/bjs.11289.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle Des Pathologies Digestives, Hépatiques Et de La Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France 1, Avenue Moliere, 67098, Strasbourg, France

    Pietro Addeo, Maxime Foguenne, Martina Guerra, Caterina Cusumano, Chloe Paul, François Faitot, Laura Fiore, Pierre De Mathelin & Philippe Bachellier

  2. ICube, Université de Strasbourg, CNRS UMR 7357, Illkirch, France

    Pietro Addeo & François Faitot

Authors
  1. Pietro Addeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maxime Foguenne
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martina Guerra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Caterina Cusumano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chloe Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. François Faitot
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Laura Fiore
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pierre De Mathelin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Philippe Bachellier
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Substantial contributions to the conception or design of the work: All.

Acquisition, analysis, or interpretation of data for the work: All.

Drafting the work or revising it critically for important intellectual content: PA, MF, PDM PB.

Final approval of the version to be published: All.

Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work is appropriately investigated and resolved: All.

Corresponding author

Correspondence to Pietro Addeo.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Addeo, P., Foguenne, M., Guerra, M. et al. Predicting Limited Survival After Resection of Synchronous Colorectal Liver Metastases: a Propensity Score Matched Comparison Between The Primary First And The Simultaneous Strategy. J Gastrointest Surg 27, 1141–1151 (2023). https://doi.org/10.1007/s11605-023-05633-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-023-05633-9

Keywords

Search

Navigation