Identifying High-risk Patients with Synchronous Colorectal Liver Metastasis: Implications for Preoperative...

Preoperative chemotherapy increases resectability in patients with resectable colorectal liver metastasis who undergo curative hepatectomy; however, there is no consensus regarding patient selection. The aim of this study was to identify high-risk patients with synchronous colorectal liver metastasis and compare the outcomes of preoperative chemotherapy with those of upfront surgery.

This multi-institutional, retrospective study enrolled patients who underwent their first liver resection for synchronous colorectal liver metastasis from January 2010 to July 2019. We retrospectively studied the clinicopathological features and prognoses of synchronous colorectal liver metastasis subjected to curative liver resection. Surgical outcomes were compared between the preoperative chemotherapy and upfront surgery groups.

We analyzed 215 patients categorized into the preoperative chemotherapy (n=111) and upfront surgery (n=104) groups. The distribution of primary colorectal cancer locations significantly differed, and the preoperative chemotherapy group had more and larger tumors than did the upfront surgery group. There were no significant between-group differences in recurrence-free survival and overall survival. Primary lymph node metastasis ≥N2, tumor burden score >5, positive carbohydrate antigen 19-9 on treatment, and the Kirsten rat sarcoma viral oncogene homolog mutation were independent risk factors for recurrence-free survival. The recurrence-free survival rate was significantly higher in the preoperative chemotheapy group than in the upfront surgery group for patients with ≥2 risk factors.

Our study suggests new criteria for identifying high-risk patients with synchronous colorectal liver metastasis and shows that preoperative chemotherapy may be an effective option for high-risk patients with ≥2 risk factors.