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07.06.2023 | Hepatobiliary Tumors

Hepatectomy Before Primary Tumor Resection as Preferred Approach for Synchronous Liver Metastases from Rectal Cancer

verfasst von: Harufumi Maki, MD, PhD, Reed I. Ayabe, MD, Yujiro Nishioka, MD, PhD, Tsuyoshi Konishi, MD, PhD, Timothy E. Newhook, MD, Hop S. Tran Cao, MD, Yun Shin Chun, MD, Ching-Wei D. Tzeng, MD, Y. Nancy You, MD, MHSc, Jean-Nicolas Vauthey, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 9/2023

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Abstract

Background

For patients with synchronous liver metastases (LM) from rectal cancer, a consensus on surgical sequencing is lacking. We compared outcomes between the reverse (hepatectomy first), classic (primary tumor resection first), and combined (simultaneous hepatectomy and primary tumor resection) approaches.

Methods

A prospectively maintained database was queried for patients with rectal cancer LM diagnosed before primary tumor resection who underwent hepatectomy for LM from January 2004 to April 2021. Clinicopathological factors and survival were compared between the three approaches.

Results

Among 274 patients, 141 (51%) underwent the reverse approach; 73 (27%), the classic approach; and 60 (22%), the combined approach. Higher carcinoembryonic antigen level at LM diagnosis and higher number of LM were associated with the reverse approach. Combined approach patients had smaller tumors and underwent less complex hepatectomies. More than eight cycles of pre-hepatectomy chemotherapy and maximum diameter of LM > 5 cm were independently associated with worse overall survival (OS) (p = 0.002 and 0.027, respectively). Although 35% of reverse-approach patients did not undergo primary tumor resection, OS did not differ between groups. Additionally, 82% of incomplete reverse-approach patients ultimately did not require diversion during follow-up. RAS/TP53 co-mutation was independently associated with lack of primary resection with the reverse approach (odds ratio: 0.16, 95% CI 0.038–0.64, p = 0.010).

Conclusions

The reverse approach results in survival similar to that of combined and classic approaches and may obviate primary rectal tumor resections and diversions. RAS/TP53 co-mutation is associated with a lower rate of completion of the reverse approach.

Adam R, de Gramont A, Figueras J, et al. Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev. 2015;41(9):729–41. https://doi.org/10.1016/j.ctrv.2015.06.006.CrossRefPubMed

Ghiasloo M, Kahya H, Van Langenhove S, et al. Effect of treatment sequence on survival in stage IV rectal cancer with synchronous and potentially resectable liver metastases. J Surg Oncol. 2019;120(3):415–22. https://doi.org/10.1002/jso.25516.CrossRefPubMed

Boudjema K, Locher C, Sabbagh C, et al. Simultaneous versus delayed resection for initially resectable synchronous colorectal cancer liver metastases: A prospective, open-label, randomized Controlled Trial. Ann Surg. 2021;273(1):49–56. https://doi.org/10.1097/SLA.0000000000003848.CrossRefPubMed

Chan AKC, Mason JM, Baltatzis M, Siriwardena AK, Co SC. Management of colorectal cancer with synchronous liver metastases: An inception cohort study (CoSMIC). Ann Surg Oncol. 2022;29(3):1939–51. https://doi.org/10.1245/s10434-021-11017-7.CrossRefPubMed

Snyder RA, Hao S, Irish W, Zervos EE, Tuttle-Newhall JE, Parikh AA. Thirty-day morbidity after simultaneous resection of colorectal cancer and colorectal liver metastasis: American college of surgeons NSQIP analysis. J Am Coll Surg. 2020;230(4):617–27. https://doi.org/10.1016/j.jamcollsurg.2019.12.018.CrossRefPubMed

Yoshioka R, Hasegawa K, Mise Y, et al. Evaluation of the safety and efficacy of simultaneous resection of primary colorectal cancer and synchronous colorectal liver metastases. Surgery. 2014;155(3):478–85. https://doi.org/10.1016/j.surg.2013.10.015.CrossRefPubMed

Shubert CR, Habermann EB, Bergquist JR, et al. A NSQIP review of major morbidity and mortality of synchronous liver resection for colorectal metastasis stratified by extent of liver resection and type of colorectal resection. J Gastrointest Surg. 2015;19(11):1982–94. https://doi.org/10.1007/s11605-015-2895-z.CrossRefPubMed

Jayne D, Pigazzi A, Marshall H, et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA. 2017;318(16):1569–80. https://doi.org/10.1001/jama.2017.7219.CrossRefPubMedPubMedCentral

Fleshman J, Branda M, Sargent DJ, et al. Effect of laparoscopic-assisted resection vs open resection of Stage II or III rectal cancer on pathologic outcomes: The ACOSOG Z6051 randomized clinical trial. JAMA. 2015;314(13):1346–55. https://doi.org/10.1001/jama.2015.10529.CrossRefPubMedPubMedCentral

10.

Bolton WS, Chapman SJ, Corrigan N, et al. The incidence of low anterior resection syndrome as assessed in an international randomized controlled trial (MRC/NIHR ROLARR). Ann Surg. 2021;274(6):e1223–9. https://doi.org/10.1097/SLA.0000000000003806.CrossRefPubMed

11.

Mentha G, Majno PE, Andres A, Rubbia-Brandt L, Morel P, Roth AD. Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg. 2006;93(7):872–8. https://doi.org/10.1002/bjs.5346.CrossRefPubMed

12.

Welsh FK, Chandrakumaran K, John TG, Cresswell AB, Rees M. Propensity score-matched outcomes analysis of the liver-first approach for synchronous colorectal liver metastases. Br J Surg. 2016;103(5):600–6. https://doi.org/10.1002/bjs.10099.CrossRefPubMed

13.

Giuliante F, Vigano L, De Rose AM, et al. Liver-first approach for synchronous colorectal metastases: Analysis of 7360 patients from the livermetsurvey registry. Ann Surg Oncol. 2021;28(13):8198–208. https://doi.org/10.1245/s10434-021-10220-w.CrossRefPubMedPubMedCentral

14.

Salvador-Roses H, Lopez-Ben S, Casellas-Robert M, et al. Oncological strategies for locally advanced rectal cancer with synchronous liver metastases, interval strategy versus rectum first strategy: a comparison of short-term outcomes. Clin Transl Oncol. 2018;20(8):1018–25. https://doi.org/10.1007/s12094-017-1818-8.CrossRefPubMed

15.

Labori KJ, Guren MG, Brudvik KW, et al. Resection of synchronous liver metastases between radiotherapy and definitive surgery for locally advanced rectal cancer: Short-term surgical outcomes, overall survival and recurrence-free survival. Colorectal Dis. 2017;19(8):731–8. https://doi.org/10.1111/codi.13622.CrossRefPubMed

16.

D’Hondt M, Lucidi V, Vermeiren K, Van Den Bossche B, Donckier V, Sergeant G. The interval approach: An adaptation of the liver-first approach to treat synchronous liver metastases from rectal cancer. World J Surg Oncol. 2017;15(1):54. https://doi.org/10.1186/s12957-017-1123-6.CrossRefPubMedPubMedCentral

17.

Buchs NC, Ris F, Majno PE, et al. Rectal outcomes after a liver-first treatment of patients with stage IV rectal cancer. Ann Surg Oncol. 2015;22(3):931–7. https://doi.org/10.1245/s10434-014-4069-8.CrossRefPubMed

18.

van der Pool AE, de Wilt JH, Lalmahomed ZS, Eggermont AM, Ijzermans JN, Verhoef C. Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases. Br J Surg. 2010;97(3):383–90. https://doi.org/10.1002/bjs.6947.CrossRefPubMed

19.

Verhoef C, van der Pool AE, Nuyttens JJ, Planting AS, Eggermont AM, de Wilt JH. The “liver-first approach” for patients with locally advanced rectal cancer and synchronous liver metastases. Dis Colon Rectum. 2009;52(1):23–30. https://doi.org/10.1007/DCR.0b013e318197939a.CrossRefPubMed

20.

Nierop PMH, Verseveld M, Galjart B, et al. The liver-first approach for locally advanced rectal cancer and synchronous liver metastases. Eur J Surg Oncol. 2019;45(4):591–6. https://doi.org/10.1016/j.ejso.2018.12.007.CrossRefPubMed

21.

Sammour T, Price BA, Krause KJ, Chang GJ. Nonoperative management or “watch and wait” for rectal cancer with complete clinical response after neoadjuvant chemoradiotherapy: A critical appraisal. Ann Surg Oncol. 2017;24(7):1904–15. https://doi.org/10.1245/s10434-017-5841-3.CrossRefPubMedPubMedCentral

22.

Fleming C, Vendrely V, Rullier E, Denost Q. Organ preservation in rectal cancer: Review of contemporary management. Br J Surg. 2022;109(8):695–703. https://doi.org/10.1093/bjs/znac140.CrossRefPubMed

23.

Custers PA, Hupkens BJP, Grotenhuis BA, et al. Selected stage IV rectal cancer patients managed by the watch-and-wait approach after pelvic radiotherapy: A good alternative to total mesorectal excision surgery? Colorectal Dis. 2022;24(4):401–10. https://doi.org/10.1111/codi.16034.CrossRefPubMedPubMedCentral

24.

Conrad C, Vauthey JN, Masayuki O, et al. Individualized treatment sequencing selection contributes to optimized survival in patients with rectal cancer and synchronous liver metastases. Ann Surg Oncol. 2017;24(13):3857–64. https://doi.org/10.1245/s10434-017-6089-7.CrossRefPubMedPubMedCentral

25.

Kawaguchi Y, Hasegawa K, Tzeng CD, et al. Performance of a modified three-level classification in stratifying open liver resection procedures in terms of complexity and postoperative morbidity. Br J Surg. 2020;107(3):258–67. https://doi.org/10.1002/bjs.11351.CrossRefPubMed

26.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae.CrossRefPubMedPubMedCentral

27.

Rahbari NN, Garden OJ, Padbury R, et al. Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149(5):713–24. https://doi.org/10.1016/j.surg.2010.10.001.CrossRefPubMed

28.

Chun YS, Vauthey JN, Boonsirikamchai P, et al. Association of computed tomography morphologic criteria with pathologic response and survival in patients treated with bevacizumab for colorectal liver metastases. JAMA. 2009;302(21):2338–44. https://doi.org/10.1001/jama.2009.1755.CrossRefPubMedPubMedCentral

29.

Kawaguchi Y, Kopetz S, Kwong L, et al. Genomic sequencing and insight into clinical heterogeneity and prognostic pathway genes in patients with metastatic colorectal cancer. J Am Coll Surg. 2021;233(2):272–84. https://doi.org/10.1016/j.jamcollsurg.2021.05.027.CrossRefPubMedPubMedCentral

30.

Brouquet A, Mortenson MM, Vauthey JN, et al. Surgical strategies for synchronous colorectal liver metastases in 156 consecutive patients: Classic, combined or reverse strategy? J Am Coll Surg. 2010;210(6):934–41. https://doi.org/10.1016/j.jamcollsurg.2010.02.039.CrossRefPubMed

31.

Chowdhury MZI, Turin TC. Variable selection strategies and its importance in clinical prediction modelling. Fam Med Commun Health. 2020;8(1):e000262. https://doi.org/10.1136/fmch-2019-000262.CrossRef

32.

Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165(6):710–8. https://doi.org/10.1093/aje/kwk052.CrossRefPubMed

33.

Chun YS, Passot G, Yamashita S, et al. Deleterious effect of RAS and evolutionary high-risk TP53 double mutation in colorectal liver metastases. Ann Surg. 2019;269(5):917–23. https://doi.org/10.1097/SLA.0000000000002450.CrossRefPubMed

34.

Lillemoe HA, Passot G, Kawaguchi Y, et al. RAS/TP53 co-mutation is associated with worse survival after concurrent resection of colorectal liver metastases and extrahepatic disease. Ann Surg. 2020. https://doi.org/10.1097/SLA.0000000000004672.CrossRefPubMed

35.

Nishioka Y, Paez-Arango N, Boettcher FO, et al. Neither surgical margin status nor somatic mutation predicts local recurrence after R0-intent resection for colorectal liver metastases. J Gastrointest Surg. 2022;26(4):791–801. https://doi.org/10.1007/s11605-021-05173-0.CrossRefPubMed

36.

Nishioka Y, Chun YS, Overman MJ, et al. Effect of co-mutation of RAS and TP53 on postoperative ctDNA detection and early recurrence after hepatectomy for colorectal liver metastases. J Am Coll Surg. 2022;234(4):474–83. https://doi.org/10.1097/XCS.0000000000000093.CrossRefPubMed

37.

Kanemitsu Y, Shitara K, Mizusawa J, et al. Primary tumor resection plus chemotherapy versus chemotherapy alone for colorectal cancer patients with asymptomatic, synchronous unresectable metastases (JCOG1007; iPACS): A randomized clinical trial. J Clin Oncol. 2021;39(10):1098–107. https://doi.org/10.1200/JCO.20.02447.CrossRefPubMedPubMedCentral

38.

Poultsides GA, Servais EL, Saltz LB, et al. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol. 2009;27(20):3379–84. https://doi.org/10.1200/JCO.2008.20.9817.CrossRefPubMedPubMedCentral

39.

You YN, Eng C, Aloia T. Multidisciplinary management of stage IV colon cancer. Semin Colon Rectal Surg. 2016;27(4):213–8. https://doi.org/10.1053/j.scrs.2016.04.020.CrossRef

40.

Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230(3):309–18. https://doi.org/10.1097/00000658-199909000-00004.CrossRefPubMedPubMedCentral

41.

Madley-Dowd P, Hughes R, Tilling K, Heron J. The proportion of missing data should not be used to guide decisions on multiple imputation. J Clin Epidemiol. 2019;110:63–73. https://doi.org/10.1016/j.jclinepi.2019.02.016.CrossRefPubMedPubMedCentral

Titel: Hepatectomy Before Primary Tumor Resection as Preferred Approach for Synchronous Liver Metastases from Rectal Cancer
verfasst von: Harufumi Maki, MD, PhD
Reed I. Ayabe, MD
Yujiro Nishioka, MD, PhD
Tsuyoshi Konishi, MD, PhD
Timothy E. Newhook, MD
Hop S. Tran Cao, MD
Yun Shin Chun, MD
Ching-Wei D. Tzeng, MD
Y. Nancy You, MD, MHSc
Jean-Nicolas Vauthey, MD
Publikationsdatum: 07.06.2023
Verlag: Springer International Publishing
Erschienen in: Annals of Surgical Oncology / Ausgabe 9/2023
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-023-13656-4

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Hepatectomy Before Primary Tumor Resection as Preferred Approach for Synchronous Liver Metastases from Rectal Cancer