The liver-first approach for synchronous colorectal liver metastases: A systematic review and meta-analysis of completion rates and effects on survival

Abstract

Background: Patients presenting with synchronous colorectal liver metastases are increasingly being considered for a curative treatment, and the liver-first approach is gaining popularity in this context. However, little is known about the completion rates of the liver-first approach and its effects on survival. Methods: A systematic review and meta-analysis of liver-first strategy for colorectal liver metastasis. The primary outcome was an assessment of the completion rates of the liver-first approach. Secondary outcomes included overall survival, causes of non-completion, and clinicopathologic data. Results: Seventeen articles were amenable for inclusion and the total study population was 1041. The median completion rate for the total population was 80% (range 20–100). The median overall survival for the completion and non-completion groups was 45 (range 12–69) months and 13 (range 10.5–25) months, respectively. Metadata showed a significant survival benefit for the completion group, with a univariate hazard ratio of 12.0 (95% confidence interval, range 5.7–24.4). The major cause of non-completion (76%) was liver disease progression before resection of the primary tumor. Pearson tests showed significant negative correlation between median number of lesions and median size of the largest metastasis and completion rate. Conclusions: The liver-first approach offers a complete resection to most patients enrolled, with an overall survival benefit when completion can be assured. One-fifth fails to return to intended oncologic therapy and the major cause is interim metastatic progression, most often in the liver. Risk of non-completion is related to a higher number of lesions and large metastases. The majority of studies stem from primary rectal cancers, which may influence on the return to intended oncologic therapy as well. PROSPERO id no: 170459

Two‐step artificial intelligence algorithm for liver segmentation automates anatomic virtual hepatectomy

“…All areas of the hemiliver, sectors, and Couinaud's segments were represented as an aggregation of voxels classified with each of the three attributes (hemiliver [left or right], sector [posterior, anterior, medial and lateral], and segment [1][2][3][4][5][6][7][8] ) on the 3D simulation data as shown in Fig- ure 2c. Attribution of these voxels for the Pure-and Semi-AI groups, and GT data were compared to determine the true positive, false positive, and false negative rates, and the similarities among the Pure-and Semi-AI groups, and the GT data.…”

“…Liver cancer is the third leading cause of cancer death, with an estimated 0.8 million deaths in 2020 1 . Hepatectomy is crucial treatment for liver cancer 2 and colorectal liver metastases 3 . To ensure a safe hepatectomy and avoid postoperative liver failure, preoperative virtual hepatectomy with three‐dimensional (3D) simulation has become the standard procedure for surgical planning and intraoperative navigation to precisely estimate the liver resection volume 4,5 …”

“…1 Hepatectomy is crucial treatment for liver cancer 2 and colorectal liver metastases. 3 To ensure a safe hepatectomy and avoid postoperative liver failure, preoperative virtual hepatectomy with three-dimensional (3D) simulation has become the standard procedure for surgical planning and intraoperative navigation to precisely estimate the liver resection volume. 4,5 Based on the Brisbane 2000 terminology, 6 the liver is anatomically divided and segmented into two hemilivers, four sectors(section), and eight segments corresponding…”

Staged or Simultaneous Surgery for Colon or Rectal Cancer with Synchronous Liver Metastases: Implications for Study Design and Clinical Endpoints

“…For staged strategies, a “conventional approach” will suggest removal of the primary tumor first (either colon or rectal cancer) and plan for liver surgery after recovery of the first operation. A “Liver first” or reversed strategy will prioritize the liver resection first [ 9 , 10 ]. Arguments have been put forward that a “liver-first” strategy is associated with improved survival [ 11 ], but such improved survival figures usually relate to those who actually are resected and “intention to treat” is often neglected in these comparative studies.…”

Efficacy and Safety of TACE Combined with Regorafenib versus TACE in the Third-Line Treatment of Colorectal Liver Metastases

“…Studies have reported that about 50% of colorectal cancer patients may have liver metastases during the course of the disease. Of these, 15-25% have synchronous liver metastases [5]. Even after achieving curative resection of the primary tumor of colorectal cancer, the chance of developing metachronous liver metastases is as high as 30% [3].…”