Liver-first approach in surgical treatment of colorectal cancer with synchronous liver metastases: results of a single-center study

BACKGROUND: At the time of initial colorectal cancer diagnosis, synchronous metastases are found in 20–25% of patients. The medical approach, in which liver resection is performed as the first stage of treatment is called liver-first. The rationality of this approach is justified by elimination of the most prognostically significant tumor foci, which are hepatic metastases, with subsequent treatment of primary colorectal tumor. AIM: To evaluate the immediate and long-term treatment results in patients with metastatic colorectal cancer, focused on surgical removal of synchronous liver metastatic foci as the first stage of treatment. MATERIALS AND METHODS: A single-center, observational, prospective cohort study was carried out from February 2017 to June 2023 in the abdominal surgical department of the P.A. Herzen Moscow State Medical Institute — a branch of the National Medical Research Radiological Center (Moscow, Russia). RESULTS: The study included 70 patients (37 men and 33 women). The treatment plan, according to the previously approved protocol, was carried out in 25 patients out of 70 (35.7%). Mean duration of the first stage was 235 min (125–328 min), mean blood loss volume 450 ml (100 ml–1300 ml). Mean hospitalization length was 17 bed days (12–21). The 30-day mortality rate was 12.8% (5 out of 39 patients). Overall, 1-year and 3-year survival rate after second stage of the treatment was 78% and 52%, respectively. At the same time, 1-year progression-free survival rate was 25%, and 3-year survival rate was 11%. CONCLUSION: In rare clinical situations, when synchronous bilobar liver metastases are accompanied by an asymptomatic primary tumor, the best choice is to follow the liver-first protocol. However, it should be noted that not every patient at stage IV colorectal cancer can be a candidate for combined two-stage treatment, which is determined by somatic status and high risk of disease progression.