Role of a liver-first approach for synchronous colorectal liver metastases

Table 1 Patients and tumor characteristics

Variable	No. of patients, n = 18
Patient characteristics
Age (yr), median (range)	54 (21-74)
Sex (male)	10
Pre-operative CEA level (μg/L), median (range)	26.3 (1-860)
Primary tumor site
Colon	2
Rectum	16
Symptoms caused by the primary tumor	13
Symptoms at the time of presentation
None	5
Rectal blood loss	7
Changes in bowel habits	6
AJCC T-stage on pathology
ypT1/ypT2	1
ypT3/ypT4	15
Lymph node status on pathology
ypN1/ypN2	14
ypN0	2
Hepatic metastasis
Size of largest metastasis (cm), median (range)	4 (2-16)
No. of metastasis, median (range)	4 (1-12)
Location (unilobular)	11
CRS score
< 3	2
≥ 3	16
Preoperative chemotherapy	14
Cycles, median (range)	3 (0-5)
Indication
Conversion	4
Locally advanced liver metastases	10
Regimens of preoperative chemotherapy
Oxaliplatin	10
Irinotecan	4
Cetuximab	4
Bevacizumab	2
Response of preoperative chemotherapy
PR	9
SD	4
PD	1

Table 2 Details of the surgical procedures and early outcomes

Variable	No. of patients, n = 18
Type of hepatic resection
Major	14
Minor	4
Extent of hepatic resection
Partial	10
Hemihepatectomy	3
Extended hepatectomy	5
Type of colorectal resection
Low anterior resection	12
Abdominoperineal resection	2
Left hemicolectomy	2
Resected lymph nodes, median (range)	11 (6-20)
Complications
Hepatectomy-related
hydrothorax	3
Abdominal abscess	1
Minor (Clavien grade < 3)	4
Major (Clavien grade ≥ 3)	0
Post-operative mortality (within 90 d)	0
Surgery on primary cancer
Anastomotic leakage	1
Abdominal abscess	2
Minor (Clavien grade < 3)	3
Major (Clavien grade ≥ 3)	0
Post-operative mortality (within 90 d)	0

Table 3 Characteristics of 18 patients who underwent the formalized treatment plan

Patient	Largest size (cm)	CEA level (μg/L)	cTN	No. of mets	CTx	Responseon CTx	Liver surgery	RTx	Primary surgery
1	16	861.4	cT3N1	1	Xelox	PD	Hemihep	None	Left Hemicol
2	2	1	cT4N2	4	Folfox	PR	Extended hemihep	None	LAR
3	3.5	13.4	cT4N1	1	None	None	Partial	30 Gy/Xeloda	LAR
4	6	113.4	cT3N1	5	Folfox	SD	Partial	None	Left Hemicol
5	2.5	16.8	cT3N1	6	Xelox	PR	Extended hemihep	30 Gy/Xeloda	None
6	7.9	30.4	cT4N1	4	Xelox	PR	Extended hemihep	None	LAR
7	4	3.2	cT2N1	3	Folifiri + Cet	PR	Hemihep	None	LAR
8	2.4	2.4	cT3N2	3	Folifiri + Cet	PR	Partial	50 Gy/Xeloda	LAR
9	5	78.1	cT4N2	1	None	None	Partial	50 Gy/Xeloda	APR
10	3.8	160.9	cT3N2	1	Folfox	SD	Partial	None	APR
11	4	3.7	cT3N0	6	Folifiri + Cet	PR	Partial	30 Gy/Xeloda	LAR
12	1.5	19.7	cT3N1	4	Folfox + Bev	PR	Partial	None	LAR
13	8.5	87.2	cT3N1	5	None	None	Partial	None	LAR
14	12	22.1	cT4N1	6	Folfox + Cet	PR	Hemihep	None	LAR
15	6	79.4	cT3N1	3	Folfoxiri	SD	Extended hemihep	None	LAR
16	4.3	6.1	cT3N0	12	Xelox + Bev	PR	Partial	None	LAR
17	3	34.7	cT3N1	2	None	None	Partial	None	LAR
18	3.5	39.0	cT3N2	6	Xelox	SD	Extended hemihep	50 Gy/Xeloda	None

LAR: Low anterior resection; APR: Abdominal perineal resection; Hemihep: Hemihepatectomy; Hemicol: Hemicolectomy; Partial: Partial hepatectomy; Cet: Cetuximab; Bev: Bevacizumab; xelox: Oxaliplatin plus capecitabine; Folfox: Oxaliplatin, leucovorin and 5-FU; Folfiri: Irinotecan, leucovorin and 5-FU; Folfoxiri: Oxaliplatin, irinotecan, leucovorin and 5-FU.