title: A survival analysis of the liver-first reversed management of advanced simultaneous colorectal liver metastases: a LiverMetSurvey-based study.
abstract: BACKGROUND
  Liver-first reversed management (RM) for the treatment of patients with simultaneous colorectal liver metastases (CRLM) includes liver-directed chemotherapy, the resection of the CRLM, and the subsequent resection of the primary cancer. Retrospective data have shown that up to 80% of patients can successfully undergo a complete RM, whereas less than 30% of those undergoing classical management (CM) do so. This registry-based study compared the 2 approaches.
  
  
  METHODS
  The study was based on the LiverMetSurvey (January 1, 2000 to December 31, 2010) and included patients with 2 or more metastases. All patients had irinotecan and/or oxaliplatin-based chemotherapy before liver surgery. Patients undergoing simultaneous liver and colorectal surgery were excluded.
  
  
  RESULTS
  A total of 787 patients were included: 729 in the CM group and 58 in the RM group. Patients in the 2 groups had similar numbers of metastases (4.20 vs 4.80 for RM and CM, P = 0.231) and Fong scores of 3 or more (79% vs 87%, P = 0.164). Rectal cancer, neoadjuvant rectal radiotherapy, and the use of combined irinotecan/oxaliplatin chemotherapy were more frequent in the RM group (P < 0.001), whereas colorectal lymph node involvement was more frequent in the CM group (P < 0.001). Overall survival and disease-free survival were similar in the RM and CM groups (48% vs 46% at 5 years, P = 0.965 and 30% vs 26%, P = 0.992).
  
  
  CONCLUSIONS
  Classical and reversed managements of metastatic liver disease in colorectal cancer are associated with similar survival when successfully completed.
authors.affiliation: Abdominal and Transplantation Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland.
authors.forename: Axel
authors.initials: A
authors.lastname: Andres
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
authors.forename: Rene
authors.initials: R
authors.lastname: Adam
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barroso
authors.forename: Catherine
authors.initials: C
authors.lastname: Hubert
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.forename: Eric
authors.initials: E
authors.lastname: Gerstel
authors.forename: Arnaud
authors.initials: A
authors.lastname: Roth
authors.forename: Pietro E
authors.initials: PE
authors.lastname: Majno
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D000077146:Irinotecan; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002166:Camptothecin