Primary tumor resection as initial synchronous colorectal liver metastases therapy increased progression risk

Patients who undergo primary tumor resection as an initial treatment for synchronous colorectal liver metastases are at increased risk for progressive disease, according to data presented at the American Society of Colon and Rectal Surgeons Annual Meeting in Phoenix.

Researchers evaluated patients with synchronous colorectal liver metastases, including 44 treated with a primary tumor resection, 55 with chemotherapy alone and 14 who received neoadjuvant therapy followed by primary tumor resection.

Progressive disease was observed in significantly more patients in the primary tumor resection group (31 cases) than either the chemotherapy only (11 cases) or neoadjuvant therapy/resection group (four cases) (P<.001 for difference). Undergoing primary tumor resection as initial therapy (OR=8.7; 95% CI, 4-20) significantly increased the likelihood of progressive disease, while chemotherapy use reduced the likelihood (OR=0.2; 95% CI, 0.08-0.4) on univariate analysis. Multivariate analysis indicated a significant association only between primary tumor resection and progressive disease (OR=5.9; 95% CI, 5.4-21.2).

Investigators noted that patients who received chemotherapy alone experienced significantly more overall liver metastases regression than those who initially received neoadjuvant therapy or resection.

“Our findings suggest that a primary tumor resection as part of a sequential resection in patients with synchronous liver metastases is an independent adverse prognostic factor and should be avoided,” the researchers wrote. “These preliminary findings need to be validated in a future independent study.”

For more information:

Slesser AA. S22: Factors Affecting Progressive Disease in Patients with Synchronous Colorectal Liver Metastases: A Pilot Study. Presented at: The American Society of Colon and Rectal Surgeons Annual Meeting 2013; April 27–May 1, Phoenix.