This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Propensity score‐matched outcomes analysis of the liver‐first approach for synchronous colorectal liver metastases. BJS 2016; 103: 600-606.

Published: 10th February 2016

Authors: F. K. S. Welsh, K. Chandrakumaran, T. G. John, A. B. Cresswell, M. Rees

Background

Liver resection before primary cancer resection is a novel strategy advocated for selected patients with synchronous colorectal liver metastases (sCRLM). This study measured outcomes in patients with sCRLM following a liver‐first or classical approach, and used a validated propensity score.

Method

Clinical, pathological and follow‐up data were collected prospectively from consecutive patients undergoing hepatic resection for sCRLM at a single centre (2004–2014). Cumulative disease‐free survival (DFS), cancer‐specific survival (CSS) and overall survival (OS) were calculated by means of Kaplan–Meier analysis. Survival differences were analysed in the whole cohort and in subgroups matched according to Basingstoke Predictive Index (BPI).

Results

Of 582 patients, 98 had a liver‐first and 467 a classical approach to treatment; 17 patients undergoing simultaneous bowel and liver resection were excluded. The median (i.q.r.) BPI was significantly higher in the liver‐first compared with the classical group: 8·5 (5–10) versus 8 (4–9) (P = 0·030). Median follow‐up was 34 months. The 5‐year DFS rate was lower in the liver‐first group than in the classical group (23 versus 45·6 per cent; P = 0·001), but there was no difference in 5‐year CSS (51 versus 53·8 per cent; P = 0·379) or OS (44 versus 49·6 per cent; P = 0·305). After matching for preoperative BPI, there was no difference in 5‐year DFS (37 versus 41·2 per cent for liver‐first versus classical approach; P = 0·083), CSS (51 versus 53·2 per cent; P = 0·616) or OS (47 versus 49·1 per cent; P = 0·846) rates.

Conclusion

Patients with sCRLM selected for a liver‐first approach had more oncologically advanced disease and a poorer prognosis. They had inferior cumulative DFS than those undergoing a classical approach, a difference negated by matching preoperative BPI.

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