Outcomes of liver-first strategy and classical strategy for synchronous colorectal liver metastases in Sweden |
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| Authors: | Valentinus T. Valdimarsson Ingvar Syk Gert Lindell Agneta Norén Bengt Isaksson Per Sandström Magnus Rizell Bjarne Ardnor Christian Sturesson |
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| Affiliation: | 1. Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Surgery, Lund, Sweden;2. Lund University, Skane University Hospital, Department of Clinical Sciences Malmö, Surgery, Malmö, Sweden;3. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden;4. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden;5. Department of Surgery, Linköping University, Linköping, Sweden;6. Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden;7. Department of Transplantation and Liver Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;8. Department of Surgery, Umeå University Hospital, Umeå, Sweden |
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| Abstract: | BackgroundPatients with synchronous colorectal liver metastases (sCRLM) are increasingly operated with liver resection before resection of the primary cancer. The aim of this study was to compare outcomes in patients following the liver-first strategy and the classical strategy (resection of the bowel first) using prospectively registered data from two nationwide registries.MethodsClinical, pathological and survival outcomes were compared between the liver-first strategy and the classical strategy (2008–2015). Overall survival was calculated.ResultsA total of 623 patients were identified, of which 246 were treated with the liver-first strategy and 377 with the classical strategy. The median follow-up was 40 months. Patients chosen for the classical strategy more often had T4 primary tumours (23% vs 14%, P = 0.012) and node-positive primaries (70 vs 61%, P = 0.015). The liver-first patients had a higher liver tumour burden score (4.1 (2.5–6.3) vs 3.6 (2.2–5.1), P = 0.003). No difference was seen in five-year overall survival between the groups (54% vs 49%, P = 0.344). A majority (59%) of patients with rectal cancer were treated with the liver-first strategy.ConclusionThe liver-first strategy is currently the dominant strategy for sCRLM in patients with rectal cancer in Sweden. No difference in overall survival was noted between strategies. |
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| Keywords: | Correspondence: Christian Sturesson Department of Surgery Skåne University Hospital S-221 85 Lund Sweden. |
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