Single-center multidisciplinary management of patients with colorectal cancer and resectable synchronous liver metastases improves outcomes - 01/02/13
, Luca Vigano a, Michael Kluger b, Alain Luciani c, Alexis Laurent a, Daniel Azoulay a, Daniel Cherqui a, b
Corresponding author. Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Pierre-et-Marie-Curie University (Paris VI), Groupe Hospitalier Pitié-Salpetrière, AP–HP, 42–83 boulevard de l’Hôpital, 75013 Paris, France. Tel.: +33 1 42 17 56 11.Bienvenue sur EM-consulte, la référence des professionnels de santé.
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Summary |
Background |
Management of patients with synchronous liver metastasis (SLM) is complex and the surgical decision process should be based on a comprehensive oncological strategy. The aim of the study was to compare outcome of single-center management of patients with colorectal cancer (CRC) and resectable SLM to those of referred patients for liver resection only after removal of their primary tumor (PT).
Methods |
Between 2000 and 2007, 47patients with CRC and SLM underwent resection of both the PT and metastases under our care (unicentric) and 32 were referred after resection of their PT.
Results |
The two groups were comparable for demographics, PT and metastatic disease data. In unicentric group, 23% received upfront chemotherapy with the PT in place, 53% had a combined CRC and SLM resection, 11% had a two-stage hepatectomy with resection of the primary during the first stage and 36% underwent delayed hepatectomy. The number of surgical interventions, the delay between diagnosis and liver resection (9 vs. 5months, P<0.001), the median number of cycles of chemotherapy before hepatectomy (12 vs. 6months, P<0.001) were significantly higher in the referred group. Postoperative morbidity was significantly higher in the referred group (75 vs. 47%, P=0.023). The median follow-up was 43months. OS and DFS were not significantly different between the two groups.
Conclusion |
Although the survival benefit is not proven, single-center management of patients with CRC and resectable SLM reduces the number of interventions, the number of cycles of chemotherapy and postoperative morbidity.
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 | The present work has been presented to the 7th congress of the SFCD-ACHBT associations (Paris, December 2011). |
Vol 37 - N° 1
P. 47-55 - février 2013 Retour au numéro
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