Feasibility of the liver-first approach for patients with initially unresectable and not optimally resectable synchronous colorectal liver metastases.

Purpose: To investigate the outcomes of patients with colorectal cancer and initially unresectable or not optimally resectable liver metastases, who were treated using the liver-first approach in the era of modern chemotherapy in Japan. Methods: We analyzed and compared data retrospectively on patients with asymptomatic resectable colorectal cancer and initially unresectable or not optimally resectable liver metastases, who were treated either using the liver-first approach ( n = 12, LF group) or the primary-first approach ( n = 13, PF group). Results: Both groups of patients completed their therapeutic plan and there was no mortality. Postoperative morbidity rates after primary resection and hepatectomy, and post-hepatectomy liver failure rate were comparable between the groups ( p = 1.00, p = 0.91, and p = 0.55, respectively). Recurrence rates, median recurrence-free survival since the last operation, and 3-year overall survival rates from diagnosis were also comparable between the LF and PF groups (58.3 vs. 61.5 %, p = 0.87; 10.5 vs. 18.6 months, p = 0.57; and 87.5 vs. 82.5 %, p = 0.46, respectively). Conclusions: The liver-first approach may be an appropriate treatment sequence without adversely affecting perioperative or survival outcomes for selected patients. [ABSTRACT FROM AUTHOR]