The "Liver-First" Approach in the Surgical Treatment of Patients With Synchronous Metastases of Colorectal Cancer in the Liver: Results of a Single-Center Study

Relevance. At the time of initial detection of colorectal cancer after further examination, synchronous metastatic liver damage is determined in 20-25% of patients. The approach in which liver resection is performed as the first stage is called "liver-first approach" in the English literature. The rationality of this approach is justified by the eradication of the most prognostically significant tumor focus corresponding to hepatic metastasis, with the possibility of subsequent treatment of primary colorectal tumor. Goal. To evaluate the immediate and long-term results of treatment of patients with metastatic colorectal cancer using an approach focused on surgical treatment of synchronous metastatic foci in the liver by the first stage. Materials and methods. The study was carried out in the design of a single–center observational prospective cohort study in the period from February 2017 to June 2023 on the basis of the abdominal surgical department of the P. A. Herzen Moscow State Medical Institute - a branch of the Federal State Budgetary Institution "NMIC of Radiology" of the Ministry of Health of Russia. The study included 70 patients (37 men and 33 women in a ratio of 1:1). Results. The treatment plan, according to the previously approved protocol, was carried out in 25 patients out of 70, which was 35.7%. The average duration of the first stage of surgery was 235 minutes (from 125 to 328 minutes), the average volume of blood loss was 450 ml (from 100 ml to 1300 ml). The average number of hospital stays was 17 bed days (from 12 to 21 bed days). The 30-day mortality rate was 12.8% (5/39). Overall survival in terms of 1 and 3 years after the end of the second stage of surgical treatment was 78% and 52%, respectively. At the same time, the 1-year progression-free survival rate was 25%, and the 3-year survival rate was 11%. Conclusion. In rare clinical situations, when synchronous bilobar metastatic liver damage is combined with an asymptomatic tumor, the best choice is to follow the "liver-first" protocol. However, it should be remembered that not every patient at stage IV of the oncological process, due to the peculiarities of his somatic status and the high risk of disease progression, can be a candidate for combined two-stage treatment.