Prognostic value of primary tumor site in surgery for colorectal liver metastases

Abstract

The compelling study by Liu et al delivers a critical verdict: The primary tumor site is not merely an anatomical detail, but a fundamental prognostic imperative in the surgical management of colorectal liver metastases. Their analysis of 178 patients definitively establishes right-sided colonic origin as an independent harbinger of aggressive disease, characterized by significantly higher recurrence rates and inferior survival outcomes compared to left-sided and rectal cancers. This biological dichotomy is further elucidated by the strong association of right-sided tumors with an adverse prognostic profile, including rampant lymph node metastasis, elevated D-dimer (reflecting a pro-thrombotic, pro-metastatic state), hypoalbuminemia, and resistance to neoadjuvant therapy. These findings necessitate an immediate paradigm shift in clinical practice. We can no longer treat colorectal cancer as a monolith. Preoperative risk stratification, surgical decision-making, and adjuvant therapy plans must be tailored according to the primary tumor location. For patients with right-sided primaries, these data suggest a more aggressive multimodal approach and vigilant, personalized surveillance to improve upon the discouraging outcomes this study clearly exposes.

Keywords: Colorectal liver metastases; Tumor location; Right-sided colon cancer; Surgical outcomes; Prognostic stratification; Cancer recurrence

Core Tip: Primary tumor location is a master prognostic regulator in colorectal liver metastases. Right-sided origin defines an aggressive biologic phenotype, marked by chemoresistance, hypercoagulability, and systemic decline, culminating in a more than 50% 1-year recurrence rate and a 13-month survival deficit. These findings mandate abandoning a one-size-fits-all management approach. Therefore, the immediate implementation of the following site-specific protocols remains paramount: Preoperative risk stratification, therapeutic intensification, and personalized intensive surveillance for right-sided cases.