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
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.
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).
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)
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.Full text
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