Simultaneous resection of liver metastasis, CRC tied to longer survival in wild-type KRAS
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Perioperative complication rates were similar between simultaneous and delayed resection of liver metastasis and colorectal cancer, although survival benefits of simultaneous resection were greater in patients with KRAS wild-type tumors.
“Up to one-fifth of patients with colorectal cancer present with synchronous liver metastasis (SLM),” Yibin Wu, MD, of Fudan University Shanghai Cancer Center in China, and colleagues wrote in JAMA Network Open. “Surgical management to remove the primary tumor and liver metastatic burden is advocated by current guidelines. ... However, for patients with CRC and SLM, the timing of colorectal and liver surgery remains controversial.”
Wu and colleagues retrospectively reviewed records of adults with CRC and resectable SLM who had curative-intent liver resection at three independent centers in China during a 19-year period. The primary outcome of the study was percentage of patients who had at least one major complication (digestive, hepatic or general) within 60 days after surgery, while secondary outcomes included intraoperative and postoperative complications, overall survival and cancer-specific survival rates.
Investigators identified 1,057 patients who underwent delayed resection and 512 patients who underwent simultaneous resection. There were more men in the delayed resection group than the simultaneous group (68% vs. 60.5%), but the mean age in both groups was approximately 57 years.
The percentage of major perioperative complications was 34.1% for the simultaneous group vs. 30% for the delayed resection group. Propensity score matching that produced 495 pairs of patients for overall survival analysis yielded better rates for simultaneous resection than delayed resection at 3, 5 and 8 years (HR = 1.42; 95% CI, 1.1-1.85). Similarly, analysis of 450 patient pairs for cancer-specific survival showed better rates at the same timepoints with simultaneous resection (HR = 1.45; 95% CI, 1.14-1.98).
However, although a subgroup analysis based on KRAS sequence variation status revealed simultaneous resection was associated with longer overall survival (HR = 1.61; 95% CI, 1.45-2.18) and cancer-specific rates (HR = 1.62; 95% CI, 1.4-1.87) at 5 years than delayed resection for patients with KRAS wild-type tumors, researchers reported overall survival and cancer-specific rates between the simultaneous and delayed resection groups among patients with KRAS sequence variation were “not statistically different.”
“To our knowledge, this study was the first to classify the underlying benefits of simultaneous vs. delayed resection of liver metastases by incorporating KRAS sequence variation data,” Wu and colleagues wrote. “The findings may inform arguments for change by clinical teams who, in the absence of evidence-based data, rely on the precautionary principle of choosing delayed resection of liver metastases from CRC.”
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