ArticleUpdates in surgery2022
Which surgical strategy for colorectal cancer with synchronous hepatic metastases provides the best outcome? A comparison between primary first, liver first and simultaneous approach.
Article in Updates in surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 3 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 3 syntheses or guidelines pooled it, 16 citations in OpenAlex.
- Systematic Review and Meta-Analysis of Resection Sequence in Synchronous Colorectal Liver Metastasis: Primary vs. Liver First.Journal of surgical oncology · 2026Pooled it
- Locally advanced mid/low rectal cancer with synchronous resectable liver metastases: systematic review of the available strategies and outcome.Updates in surgery · 2024Pooled 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
- Colorectal Cancer Screening Beyond Primary Care: A Community-Based FIT Distribution Model Serving a Safety-Net Hospital Population.Cancer medicine · 2026Article
- Primary tumor sidedness is not prognostic factor in resectable colorectal cancer liver metastasis: a retrospective observational cohort study.Annals of surgical treatment and research · 2024Article
- Feasibility and Short-Term Outcomes in Liver-First Approach: A Spanish Snapshot Study (the RENACI Project).Cancers · 2024Article
- RoboticHeliyon · 2024Article
- The role of superior hemorrhoidal vein ectasia in the preoperative staging of rectal cancer.Frontiers in oncology · 2024Article
- Colorectal Cancer: Current Updates and Future Perspectives.Journal of clinical medicine · 2023Review
- Artificial Intelligence to Early Predict Liver Metastases in Patients with Colorectal Cancer: Current Status and Future Prospectives.Life (Basel, Switzerland) · 2023Review
- Article
- Hepatic Resection in Patients with Colo-Rectal Liver Metastases: Surgical Outcomes and Prognostic Factors of Single-Center Experience.Journal of clinical medicine · 2023Article
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Authors and funding
8 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is no clear consensus about the best surgical strategy for patients with colorectal cancer (CRC) and synchronous liver metastases (SCRLM).
methodsBetween 2009 and 2019, patients with CRC and SCRLM considered for curative treatment were included. Perioperative and follow-up data were analysed to examine the safety and survival outcomes of primary first (PF), liver first (LF) and simultaneous resection (SR) strategies.
results204 patients were identified, consisting of PF (n = 129), LF (n = 26) and SR (n = 49). Forty-five patients (22.1%) failed to have either the primary or the liver metastases resected following initial LF (n = 11, 42.3%) or PF (n = 34, 26.4%), respectively (p < 0.001). The postoperative morbidity rates were 31.0%, 38.4% and 40.8% in PF, LF and SR group, respectively (p = 0.409); the mortality rates were 2.3%, 0% and 4.1%, respectively (p = 0.547). The 1-, 3- and 5-year overall survival (OS) were 94%, 72%, 53% in the PF group, 74%, 54%, 36% in the LF group, and 91%, 74%, 63% in the SR group. LF group had the worst OS compared to PF and SR (p = 0.040, p = 0.052). The 1-, 3- and 5-year disease-free survival (DFS) were 31%, 15%, 10% in PF, 21%, 9% and 9% in LF and 45%, 28% and 28% in SR group, respectively. SR group had a better DFS compared to PF and LF (p = 0.005, p = 0.008). At the multivariate analysis, there was no difference between the three strategies in terms of OS (PF vs SR OS-HR 1.090, p = 0.808; LF vs SR OS-HR 1.582, p = 0.365) and the PF had a worse DFS compared to the SR approach (PF vs SR DFS-HR 1.803, p = 0.007; LF vs SR DFS-HR 1.252, p = 0.492).
conclusionsPF, LF and SR had comparable postoperative morbidity and mortality. The three surgical strategies had similar OS outcomes. The PF strategy was associated with a worse DFS than SR, while the LF approach was associated with a high failure rate to progress to the second stage (primary tumour resection).
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