Erschienen in:
26.07.2021 | ASO Author Reflections
ASO Author Reflections: The Liver-First Approach: A New Standard for Patients with Multiple Bilobar Colorectal Metastases?
verfasst von:
Felice Giuliante, MD, Luca Viganò, MD, PhD, Agostino M. De Rose, MD, PhD, René Adam, MD
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 13/2021
Einloggen, um Zugang zu erhalten
Excerpt
The best surgical strategy for patients with colorectal cancer and synchronous liver metastases is a matter of endless debate. Technical and oncological issues must be considered but have often been confounded. In 2006, Mentha et al.
1 proposed an innovative and convincing oncosurgical approach, whereby they reversed the strategy, focusing attention on the prognostically most relevant target, i.e. the liver. Even if appealing, the liver-first approach struggled to find its role and failed to demonstrate a benefit, except for the inclusion of chemoradiotherapy in the treatment schedule of patients with locally advanced rectal tumors. The proposers themselves reported non-inferiority (and not superiority) of the reverse strategy in comparison with the standard primary-first approach.
2 A recent network meta-analysis ranked the liver-first approach as the best treatment option for its relative efficacy based on 5-year overall survival outcomes,
3 but the evidence is too weak to impact current clinical practice. …
