ArticleAnnals of surgical oncology2021
Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry.
Article in Annals of surgical oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07224724 (Exosome-derived Extrahepatic Metastasis Detection By Liquid Biopsy In Colorectal Cancer Liver Metastases), which is not on this map. Cited by 51 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Exosome-derived Extrahepatic Metastasis Detection By Liquid Biopsy In Colorectal Cancer Liver Metastases
Who cites it
51 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Systematic Review and Meta-Analysis of Resection Sequence in Synchronous Colorectal Liver Metastasis: Primary vs. Liver First.Journal of surgical oncology · 2026Pooled it
- Liver-first approach to the treatment of patients with synchronous colorectal liver metastases: a systematic review and meta-analysis.Einstein (Sao Paulo, Brazil) · 2024Pooled it
- Biological Resectability in Colorectal Liver Metastases: A Nomogram-Based Continuous Risk Model to Define Borderline Disease.Annals of gastroenterological surgery · 2026Article
- Risk Factors for Anastomotic Leaks in Simultaneous Resection of Primary Colon Cancer with Synchronous Liver Metastasis: A NSQIP Study.Annals of surgical oncology · 2026Article
- Hepatectomy After Progressive Disease Following Chemotherapy for Colorectal Liver Metastases: A Japanese Nationwide Cohort Study.Annals of surgical oncology · 2026Article
- Disparities in Surgical Care of Patients with Colorectal Cancer Liver Metastases.Annals of surgical oncology · 2026Article
- Application of indocyanine green fluorescence-guided laparoscopic hepatectomy in patients with liver metastases: a retrospective single‑center study.BMC surgery · 2026Article
- Review
- How to Integrate Surgery into the Multidisciplinary Treatment of Liver-Only Metastatic Colorectal Cancer.Cancers · 2026Review
- Article
- Iterative Hepatic and Pulmonary Metastasectomy in Stage IV Colorectal Cancer: Impact on Survival and Surgical Outcomes.Annals of surgical oncology · 2026Article
- Comprehensive management of synchronous colorectal liver metastases at a high-volume center: a propensity score-matched analysis.Updates in surgery · 2025Article
- Tissue-Specific Immunosuppressive and Proliferating Macrophages Fuel Early Metastatic Progression of Human Colorectal Cancer to the Liver.Cancer immunology research · 2025Article
- Long-term survival after multimodality treatment of metastatic mixed adenoneuroendocrine carcinoma of colon: A case report.World journal of gastrointestinal surgery · 2025Article
- Oncological safety of portal vein embolization without prior tumour clearance in the future liver remnant followed by one-stage hepatectomy for bilateral colorectal liver metastases.The British journal of surgery · 2025Article
- Outcomes of simultaneous resection for colorectal liver metastases: A nationwide cohort study (2005-2022).Surgery open science · 2025Article
- The Role of KRAS Status Among Patients Undergoing Staged Versus Simultaneous Resection for Synchronous Colorectal Liver Metastases.Journal of surgical oncology · 2025Article
- "Two-stage resection of synchronous liver metastases in colorectal cancer leads to a survival benefit: a retrospective comparative cohort study".Langenbeck's archives of surgery · 2025Article
- Prognostic Factors in Colorectal Liver Metastases: An Exhaustive Review of the Literature and Future Prospectives.Cancers · 2025Review
- Current status and advances in the treatment of colorectal cancer with liver metastases.World journal of clinical oncology · 2025Review
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18 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe liver-first approach in patients with synchronous colorectal liver metastases (CRLM) has gained wide consensus but its role is still to be clarified. We aimed to elucidate the outcome of the liver-first approach and to identify patients who benefit at most from this approach.
methodsPatients with synchronous CRLM included in the LiverMetSurvey registry between 2000 and 2017 were considered. Three strategies were analyzed, i.e. liver-first approach, colorectal resection followed by liver resection (primary-first), and simultaneous resection, and three groups of patients were analyzed, i.e. solitary metastasis, multiple unilobar CRLM, and multiple bilobar CRLM. In each group, patients from the three strategy groups were matched by propensity score analysis.
resultsOverall, 7360 patients were analyzed: 4415 primary-first, 552 liver-first, and 2393 simultaneous resections. Compared with the other groups, the liver-first group had more rectal tumors (58.0% vs. 31.2%) and higher hepatic tumor burden (more than three CRLMs: 34.8% vs. 24.0%; size > 50 mm: 35.6% vs. 22.8%; p < 0.001). In patients with solitary and multiple unilobar CRLM, survival was similar regardless of treatment strategy, whereas in patients with multiple bilobar metastases, the liver-first approach was an independent positive prognostic factor, both in unmatched patients (3-year survival 65.9% vs. primary-first 60.4%: hazard ratio [HR] 1.321, p = 0.031; vs. simultaneous resections 54.4%: HR 1.624, p < 0.001) and after propensity score matching (vs. primary-first: HR 1.667, p = 0.017; vs. simultaneous resections: HR 2.278, p = 0.003).
conclusionIn patients with synchronous CRLM, the surgical strategy should be decided according to the hepatic tumor burden. In the presence of multiple bilobar CRLM, the liver-first approach is associated with longer survival than the alternative approaches and should be evaluated as standard.
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