title: The effect of a primary tumour resection on the progression of synchronous colorectal liver metastases: an exploratory study.
abstract: OBJECTIVE
  The objective of this study was to determine the effect of an upfront primary tumour resection on the progression of synchronous colorectal liver metastases.
  
  
  METHODS
  Patients with synchronous colorectal liver metastases referred between 2005 and 2010 were identified. Patients were analysed according to the following two groups: 1) an upfront primary tumour resection and 2) neo-adjuvant chemotherapy. A univariate and multivariate analysis was performed to identify factors significantly contributing to progressive disease. Cox regression analysis was undertaken to determine the effect of management on overall survival (OS) and time to tumour progression (TTP).
  
  
  RESULTS
  A total of 116 patients with synchronous colorectal liver metastases were identified of which 49 patients received an upfront primary tumour resection and 67 received neo-adjuvant chemotherapy. Liver resections were performed in 18 (36.7%) and 14 (20.9%) of the patients in the upfront and neo-adjuvant groups respectively (P 0.06). On multivariate analysis, an upfront primary tumour resection significantly affected progressive disease (p < 0.001, OR 5.67; 95% CI 2.71-11.79). An upfront tumour resection was not a significant predictor of overall survival (P = 0.83; HR 1.10; 95% CI 0.48-2.52).
  
  
  CONCLUSIONS
  Our findings suggest that an upfront primary tumour resection in patients with synchronous colorectal liver metastases results in progressive disease. These preliminary findings need to be validated in a future multi-centre independent study.
authors: Department of Colorectal Surgery, The Royal Marsden Hospital, Fulham Road, London, UK; Division of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, UK.
authors: A A P
authors: AA
authors: Slesser
authors: Department of Oncology, The Royal Marsden Hospital, Fulham Road, London, UK.
authors: F
authors: F
authors: Khan
authors: Department of Oncology, The Royal Marsden Hospital, Fulham Road, London, UK.
authors: I
authors: I
authors: Chau
authors: Department of Hepato-Biliary Surgery, The Royal Marsden Hospital, Fulham Road, London, UK.
authors: A Z
authors: AZ
authors: Khan
authors: Division of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, UK; Department of Hepato-Biliary Surgery, The Royal Marsden Hospital, Fulham Road, London, UK.
authors: S
authors: S
authors: Mudan
authors: Department of Colorectal Surgery, The Royal Marsden Hospital, Fulham Road, London, UK; Division of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, UK.
authors: P P
authors: PP
authors: Tekkis
authors: Department of Radiology, The Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK; Division of Medicine, Imperial College London, UK. Electronic address: Gina.Brown@rmh.nhs.uk.
authors: G
authors: G
authors: Brown
authors: Department of Oncology, The Royal Marsden Hospital, Fulham Road, London, UK.
authors: S
authors: S
authors: Rao
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin
keywords: Colorectal cancer; Hepatic metastases; Synchronous colorectal liver metastases