Impact of Hepatectomy First in Management of Stage IV Colon Cancer with Synchronous Liver Metastases
*Vadim Kurbatov, *Benjamin Resio, *Danielle Heller, *Jun Lu, Sajid Khan
Yale College of Medicine, New Haven, CT
Patients with resectable synchronous colon liver metastasis (SCLM) can be surgically managed with different approaches. No level 1 data shows which approach equates to best clinical outcomes. In this study, we evaluate which treatment approach equates to the best clinical outcome for patients who present with SCLM.
The National Cancer Database was queried from 2004-2015 for stage IV colon adenocarcinoma. Patients with isolated SCLMs who underwent hepatectomy were divided into 2 groups: hepatectomy-first and either colectomy-first or simultaneous colectomy and hepatectomy.
Main Outcome Measures:
Clinical characteristics and survival were compared between each group.
Of 508,820 patients diagnosed with colon adenocarcinoma, 32,476 (63.8%) had SCLMs. Of these, 4138 (5%) were treated with a hepatectomy-first approach. On Chi Square analysis, these patients more likely to possessed the following clinicopathologic features: age <60 years (P<0.0001), non-white (P<0.0001), primary tumor size <4cm (P<0.0001), no lymph node metastases (p<.0001), received chemotherapy (P<0.0001), and treated at an academic center (p<.05). After adjusting for patient, treatment and tumor characteristics, individuals treated with a hepatectomy-first approach were less likely to die than those who underwent a colectomy-first or simultaneous hepatectomy and colectomy approach, with respective 5-year survivals of 47% vs. 29% (HR: 0.64 (95CI: 0.61-0.68) P<0.0001). [Figure 1].
In the United States, a hepatectomy-first approach to managing SCLM is infrequently used even though it is associated with increased survival, particularly when subsequent colectomy is completed. There is a need for better understanding of the biological underpinnings which may explain these results.
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