LAUSR

Introduction:Whether the liver first approach is beneficial in patients with multiple bilobar synchronous colorectal liver metastases (CLM) undergoing one-stage hepatectomy (OSH) remains to be demonstrated. The aim of this study was to assess the feasibility and outcome of the liver-first approach for patients with synchronous CLM receiving OSH. Methods: Between 2012 and 2016, 210 patients with multiple bilobar ( 4) CLM, of which at least one in contact with firstor second-order portal branches and/or with hepatic vein at caval confluence, underwent OSH. Of these, 19 (9%) patients underwent the liver-first approach as approved by our multidisciplinary team. All patients received perioperative system chemotherapy and had partial response or stable disease. Results: The median CLM number and size were 12 (range 5-45) and 3.7 (0.7-17 cm) respectively. The location of the primary tumor was in the rectum in 5 (26%) and in the colon in 14 (74%) patients. The median chemotherapy courses were 11 (range 4-16). The strategy was completed in 18 patients (95%). One patient developed hepatic disease progression. 90-day postoperative morbidity and mortality were 26% and 0% after liver resection and 19% and 0% after colorectal resection. After a median follow-up of 19 months (range 6-33), the intention-to-treat 2-year overall survival was 40% (Figure). Twelve (63%) patients developed disease recurrence. Conclusions: The liver-first approach is safe and feasible in most of the patients with advanced synchronous CLM. Despite a high rate of disease recurrence, acceptable overall survival may be achieved.