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Aim: Multidisciplinary management of metastatic colorectal liver metastases (CRLM) is still challenging. To assess postoperative complications in initially unresectable or borderline resectable CRLM, the prospective EORTC-1409 ESSO 01-CLIMB trial capturing 'real-life data' of European centres specialized in liver surgery was initiated., Material and Methods: A total of 219 patients were registered between May 2015 and January 2019 from 15 centres in nine countries. Eligible patients had borderline or initially unresectable CRLM assessed by pre-operative multidisciplinary team discussion (MDT). Primary endpoints were postoperative complications, 30-day and 90-days mortality post-surgery, and quality indicators. We report the final results of the 151 eligible patients that underwent at least one liver surgery., Results: Perioperative chemotherapy with or without targeted treatment were administered in 100 patients (69.4%). One stage resection (OSR) was performed in 119 patients (78.8%). Two stage resections (TSR, incl. Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy (ALPPS)) were completed in 24 out of 32 patients (75%). Postoperative complications were reported in 55.5% (95% CI: 46.1-64.6%), 64.0% (95% CI: 42.5-82%), and 100% (95% CI: 59-100%) of the patients in OSR, TSR and ALPPS, respectively. Post-hepatectomy liver failure occurred in 6.7%, 20.0%, and 28.6% in OSR, TSR, and ALPPS, respectively. In total, four patients (2.6%) died after surgery., Conclusion: Across nine countries, OSR was more often performed than TSR and tended to result in less postoperative complications. Despite many efforts to register patients across Europe, it is still challenging to set up a prospective CRLM database., Competing Interests: Declaration of competing interests Carmela Caballero reports a relationship with European Society of Surgical Oncology that includes: non-financial support. Michel Ducreux reports a relationship with Roche that includes: consulting or advisory, funding grants, and speaking and lecture fees. Michel Ducreux reports a relationship with Merck Serono that includes: consulting or advisory, funding grants, and speaking and lecture fees. Michel Ducreux reports a relationship with Amgen that includes: consulting or advisory. Michel Ducreux reports a relationship with Sanofi that includes: consulting or advisory and speaking and lecture fees. Michel Ducreux reports a relationship with Bayer that includes: consulting or advisory and speaking and lecture fees. Michel Ducreux reports a relationship with Lilly that includes: consulting or advisory and speaking and lecture fees. Michel Ducreux reports a relationship with Celgene that includes: consulting or advisory and speaking and lecture fees. Michel Ducreux reports a relationship with Servier that includes: consulting or advisory and speaking and lecture fees. Michel Ducreux reports a relationship with Ipsen that includes: consulting or advisory. Michel Ducreux reports a relationship with Pierre Fabre that includes: consulting or advisory. Michel Ducreux reports a relationship with Pfizer that includes: funding grants. Serge Evrard represents as study coordinator the EORTC study team. Carmela Caballero declares that she has a (uncompensated) leadership position at the European Society of Surgical Oncology. Michel Ducreux's wife is head of the oncology business unit at Sandoz France., (© 2023 Published by Elsevier Ltd.)

Background: Cytoreductive peritoneal surgery (CRS) associated with hyperthermic peritoneal chemotherapy (HIPEC) has long been considered the standard treatment for colorectal peritoneal metastases (CPM). However, although efficacy of surgery has been demonstrated, evidence supporting HIPEC's role is less certain., Method: Overall survival (OS), progression-free survival (PFS) and morbidity were analysed retrospectively for fifty consecutively included patients treated for colorectal CPM with complete CRS and systemic chemotherapy only., Results: Median peritoneal cancer index (PCI) was 8 (range 1-24). 23 patients had liver or lung metastases (LLM). 22 patients had synchronous CPM. 27 complications occurred (12 Grade 1/2, 14 Grade 3, 1 Grade 4a, 0 Grade 5). Median follow-up was 62.5 months (95 %CI 45.4-81.3), median survival 32.4 months (21.5-41.7). Three- and 5-year OS were 45.5% (0.31-0.59) and 29.64% (0.17-0.44) respectively. Presence of LLMs associated with peritoneal carcinomatosis was significantly associated with poorer prognosis, with survival at 5 years of 13.95% (95 %CI 2.9-33.6) vs. 43.87% (22.2-63.7) when no metastases were present (P= 0.018). Median PFS was 9.5 months (95 %CI 6.2-11.1)., Conclusion: With an equivalent PCI range and despite one of the highest rates of LLM in the literature, our survival data of CRS + systemic chemotherapy only compare well with results reported after additional HIPEC. Tolerance was better with acceptable morbidity without any mortality. Extra-hepatic metastasis (LLM) is a strong factor of poor prognosis. Awaiting the results of the randomized PRODIGE trial, these results indicate that CRS + systemic chemotherapy only is a robust hypothesis to treat colorectal CPM.