Trends and Outcomes of the Liver-First Surgical Approach for Patients with Colorectal Cancer and Isolated Liver...

The optimal sequencing for resection of primary and liver metastases in stage IV colorectal cancer (CRC) remains debated. This study evaluated utilization trends and outcomes of liver resection before colon/rectal resections.

A retrospective analysis was performed using the National Cancer Database (2010-2020) for patients with stage IV CRC and isolated liver metastases who underwent resection of primary CRC and liver metastases. The study identified two cohort groups: a group that underwent liver resection before colon/rectal resection (LRCR) and a group that underwent colon/rectal resection synchronous with or before liver resection (CRLR). Overall survival (OR) was evaluated using Cox proportional hazard models, whereas logistic regression was used for binary outcomes.

Among 10,959 patients, 1178 underwent LRCR and 9781 underwent CRLR. Utilization of LRCR increased from 5.37% in 2010 to 15.43% in 2020. Predictors of LRCR utilization included rectal primary sites (OR, 5.88; 95% confidence interval [CI], 4.55-7.60) and academic treatment facilities (OR, 2.74; 95% CI, 1.25-6.00). Predictors of lower LRCR included lymphovascular invasion (OR, 0.69; 95% CI, 0.54-0.87) and moderate (OR, 0.61; 95% CI, 0.39-0.95) to poorly differentiated (OR, 0.47; 95% CI, 0.27-0.81) pathology. Patients undergoing the LRCR approach were associated with better overall survival than those undergoing CRLR (hazard ratio, 0.87; 95% CI, 0.77-0.99). The 90-day mortality (1.11% vs 4.47%; p < 0.01) and 30-day readmissions (3.69% vs 5.81%; p<0.01) after primary tumor resection were lower in the LRCR group.

The LRCR approach has been increasingly used over time. Compared with CRLR, the LRCR approach was associated with better overall survival, lower postoperative mortality and fewer readmissions after colon/rectal resection.