Colorectal cancer with synchronous liver metastases: does global management at the same centre improve results?

Clin Res Hepatol Gastroenterol. 2013 Feb;37(1):56-63. doi: 10.1016/j.clinre.2012.02.002. Epub 2012 Apr 25.

Abstract

Background: Synchronous liver metastases (SLM) occur in 20% of colorectal cancers (CRC). Resection of SLM and CLC can be undertaken at different centres (separate management, SM) or at the same centre (global management, GM).

Methods: Retrospective study of SLM and CRC resections carried out during 01/2000 - 12/2006 by SM or GM, using a combined or delayed strategy.

Results: Morphologic characteristics and type of CRC and SLM resection were similar for the GM (n = 45) or SM (n = 66) groups. In patients with delayed liver resection (62 SM, 17 GM), chemotherapy prior to liver surgery was used in 92% and 38% of SM and GM patients (P < 0.0001) and the median delay between procedures was 212 and 182 days, respectively (P = 0.04). First step of liver resection was more often performed during colorectal surgery in the GM group (62 vs. 6% for SM, P < 0.0001) and the mean number of procedures (CRC+SLM) was lower (1.6 vs. 2.3, P = 0.003). Three-month mortality was 3% for GM and 0% for SM (n.s.). Overall survival rates were 67% and 51% for SM and GM at 3 years (n.s.), and 35 and 31% at 5 years (n.s.). Disease-free survival to 5 years was higher in SM patients (14% vs. 11%, P = 0.009).

Conclusions: GM of CRC and SLM was associated with fewer procedures but did not influence overall survival. SM was associated with a longer delay and increased use of chemotherapy between procedures, suggesting that more rigorous selection of SM patients for surgery may explain the higher disease-free survival after SLM resection.

MeSH terms

  • Colorectal Neoplasms / pathology*
  • Colorectal Neoplasms / surgery*
  • Colorectal Neoplasms / therapy
  • Combined Modality Therapy
  • Female
  • Humans
  • Liver Neoplasms / secondary*
  • Liver Neoplasms / surgery*
  • Liver Neoplasms / therapy
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome