title: Stage IV colorectal cancer: outcomes following the liver-first approach.
abstract: BACKGROUND
  To date, there is limited data on the liver-first approach in the management of colorectal liver metastases (CRLM). The aim of the study was to assess the outcomes of the liver-first approach for patients with synchronous CRLM in two tertiary referral centers.
  
  
  METHODS
  Patients with stage IV colorectal cancer selected for the liver-first approach from January 2009 to December 2012 in two tertiary referral centers were included. Data collated included demographics, chemotherapy, operative findings, histo-pathological features, and survival.
  
  
  RESULTS
  Thirty-seven patients with synchronous CRLM were considered for the liver-first approach. Twenty-five patients had rectal cancer. All patients underwent induction chemotherapy. Thirty patients underwent hepatic resections with no post-operative deaths. Following liver resection, five patients failed to proceed to colorectal resection and one patient had complete response to chemo-radiotherapy. Of the 25 patients that completed the liver-first approach, 13 patients had recurrent disease, of which 12 patients died. The overall 1- and 3-year survival rates were 65.9% and 30.4%, respectively.
  
  
  CONCLUSIONS
  The liver-first approach is a feasible strategy for patients with synchronous CRLM and may improve survival in selected patients. The selection of patients should be incorporated in a multidisciplinary approach to achieve the best possible outcomes.
authors.affiliation: Department of Hepatobiliary Surgery and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Antonella
authors.initials: A
authors.lastname: de Rosa
authors.forename: Dhanwant
authors.initials: D
authors.lastname: Gomez
authors.forename: Sina
authors.initials: S
authors.lastname: Hossaini
authors.forename: Katie
authors.initials: K
authors.lastname: Duke
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Fenwick
authors.forename: Adam
authors.initials: A
authors.lastname: Brooks
authors.forename: Graema J
authors.initials: GJ
authors.lastname: Poston
authors.forename: Hassan Z
authors.initials: HZ
authors.lastname: Malik
authors.forename: Iain C
authors.initials: IC
authors.lastname: Cameron
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin
keywords: colorectal cancer; liver metastases; liver-first; reverse strategy and hepatectomy