Impact of the curative treatment of colorectal liver metastases

Local and systemic treatments of colorectal liver metastases can improve survival and be curative. We aimed in our study to evaluate survival outcomes of liver treatment and to identify characteristics of the population which can benefit the most from this curative strategy.

We conducted, in a Tunisian center, a retrospective study that included 52 patients treated for metastatic colorectal cancers with liver metastases. Patients received local treatment for liver lesions and primary tumors between 2012 and 2021. Survival outcomes: Overall Survival(OS) and disease free survival (DFS) and prognostic factors were determined using Kaplan Meier and Cox model respectively.

Mean age was 53.4 years old [18-37] and 61.5% of our population were male. Primary tumor sites were the left colon in 57.7%, right colon in 23.1% and rectum in 19.2%. Synchronous liver metastases were registered in 75% of cases. Median number of liver metastases was 3 [1-15]. Four liver metastases or less were noted in 80.8% of cases. The largest diameter of liver metastasis was 4 cm or less in 51.9% of cases. Liver metastases were bilobar in 55.8% of patients (right lobe: 79%, left lobe: 21%). Liver lesions were classified as“resectable” and “potentially resectable” in 71% and 29 % of cases respectively. Perioperative chemotherapy (CT) was administered in 38.5%, postoperative CT in 25% and total preoperative CT in 36.5% of cases. Twelve patients (23%) received preoperative targeted therapies. All patients underwent liver surgery. Radiofrequency ablation and microwave ablation were performed in 4 and 2 patients respectively. Liver resection was complete (R0) in 73%, R1 in 24% and R2 in 4% of cases. Complete pathological response after liver surgery was registered in 4 cases. Hepatic sinusoidal obstruction syndrome (SOS) and chemotherapy associated steatohepatitis (CASH) were registered in 25% and 10% of cases respectively. Maintenance with 5-fluorouracil based CT after liver local treatment and peri/pre/post CT was administered to 11 patients. After liver treatment median DFS was 19 months [16.4 -21.56]. Patients who had not previously received adjuvant chemotherapy after resection of their primary tumor presented with better median DFS (34 months vs 20 months, p:0.054). Complete resection R0 was an independent factor improving DFS (p=0.01). Median OS was 58 months [33,8 -82,15]. Based on logistic regression, the factors correlating to a worse OS were age ≥ 55 years (p=0.041), bilobar metastases (p=0.001) and liver resection R1 or R2 (p < 0.001).

Exposure to adjuvant chemotherapy may impact negatively DFS. Complete resection was an independent factor improving survival of patients with colorectal liver metastases.

The authors.

Has not received any funding.

All authors have declared no conflicts of interest.