title: Single-center multidisciplinary management of patients with colorectal cancer and resectable synchronous liver metastases improves outcomes.
abstract: BACKGROUND
  Management of patients with synchronous liver metastasis (SLM) is complex and the surgical decision process should be based on a comprehensive oncological strategy. The aim of the study was to compare outcome of single-center management of patients with colorectal cancer (CRC) and resectable SLM to those of referred patients for liver resection only after removal of their primary tumor (PT).
  
  
  METHODS
  Between 2000 and 2007, 47 patients with CRC and SLM underwent resection of both the PT and metastases under our care (unicentric) and 32 were referred after resection of their PT.
  
  
  RESULTS
  The two groups were comparable for demographics, PT and metastatic disease data. In unicentric group, 23% received upfront chemotherapy with the PT in place, 53% had a combined CRC and SLM resection, 11% had a two-stage hepatectomy with resection of the primary during the first stage and 36% underwent delayed hepatectomy. The number of surgical interventions, the delay between diagnosis and liver resection (9 vs. 5 months, P < 0.001), the median number of cycles of chemotherapy before hepatectomy (12 vs. 6 months, P < 0.001) were significantly higher in the referred group. Postoperative morbidity was significantly higher in the referred group (75 vs. 47%, P = 0.023). The median follow-up was 43 months. OS and DFS were not significantly different between the two groups.
  
  
  CONCLUSIONS
  Although the survival benefit is not proven, single-center management of patients with CRC and resectable SLM reduces the number of interventions, the number of cycles of chemotherapy and postoperative morbidity.
authors.affiliation: Department of Digestive and Hepatobiliary Surgery, AP-HP, Henri-Mondor University Hospital, 94000 Créteil, France.
authors.forename: Perrine
authors.initials: P
authors.lastname: Goyer
authors.forename: Mehdi
authors.initials: M
authors.lastname: Karoui
authors.forename: Luca
authors.initials: L
authors.lastname: Vigano
authors.forename: Michael
authors.initials: M
authors.lastname: Kluger
authors.forename: Alain
authors.initials: A
authors.lastname: Luciani
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome