Two Decades of Multimodal Management of Colorectal Liver Metastases With Long‐Term Outcomes

BACKGROUND: The management of patients with colorectal liver metastases (CRLM) is complex and requires a tailored approach based on disease extent, patient age, and comorbidities. Given the heterogeneity in presentation and evolving treatment algorithms, prognostic factors for long-term survival following liver resection are contested. This study aimed to evaluate "real-world" outcomes in patients with long-term follow-up after potentially curative liver resection at a tertiary Australian center. METHODS: A retrospective analysis was conducted on prospectively collected data from patients who underwent first-time liver resection for CRLM between 1998 and 2018. Standardized clinical, biochemical, and radiological follow-up was undertaken. Multivariable Cox regression analysis was used to identify independent predictors of overall survival (OS), measured from the diagnosis of liver metastases to death or last contact. RESULTS: Of 396 patients who underwent resection, 320 met the inclusion criteria. The median follow-up was 123.3 months (95% CI: 110.5-131.0), median OS was 69.6 months (95% CI: 57.2-84.5), and the 10-year OS rate was 33%; 5-year and 10-year disease-free survival rates were 29% and 25%, respectively. Neoadjuvant chemotherapy was administered in 72% of patients, with 25% receiving targeted therapy in this setting. Postoperative (adjuvant or recurrence-related) chemotherapy was given to 50% of patients, with 17% also receiving targeted therapy. Independent predictors of poor OS included older age, right-sided primary tumours, large liver tumours, administration of locoregional liver therapy, and the use of chemotherapy ± targeted therapy in both the neoadjuvant and adjuvant settings. CONCLUSION: One-third of patients who undergo liver resection for CRLM achieve long-term survival. While multi-modal therapy was commonly used, determining the specific contribution of non-surgical treatments is challenging in a real-world cohort where treatment paradigms evolved over time. This study provides rare 10-year follow-up data and reinforces the need for ongoing refinement of personalised management strategies for CRLM.