Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Participants should be aware of the following financial/non-financial relationships:
Ian Solsky, MD, MPH: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Introduction: Although colorectal hepatic metastases (HM) and peritoneal surface disease (PSD) are distinct biologic diseases, they may have similar long-term survival when treated optimally with surgery.
Methods: This is a retrospective review of prospectively managed databases (HM data from a multicenter international database; PSD data from a large single center database). Patients undergoing R0 or R1 resections were analyzed with descriptive stats, Kaplan-Meier method, and Cox regression. Survival was compared over time: 1993-2006, 2007-2012, 2013-2020.
Results: 783 HM patients undergoing liver resection and 206 PSD patients undergoing complete cytoreduction-HIPEC were included. HM vs. PSD patients more often had R0 resections (90.3% vs. 25.2%), less often had neoadjuvant chemo (52.4% vs. 68%), and less often were functionally independent (79.7% vs. 95.1%). Five-year overall survival for HM was 40.6% with median survival of 45.7 months vs. 25.4% and 33.4 months in PSD (p < 0.05). When comparing HM and PSD outcomes over the three time periods, overall survival was similar during the first two. After 2012, survival of HM markedly increased resulting in significant differences compared to PSD.However when stratified by resection status over the study periods, R0 HM and R0 PSD had no significant difference in median survival (48.2 vs 40.6 months, p = 0.46); median survival following R1 resection was also similar among HM and PSD (32.6 vs. 26.2 months; p = 0.51).Predictors of survival in HM patients included R0 resection (HR 0.69 95% CI 0.49-0.98), number of lesions (HR 1.1 95% CI 1.05-1.16 per 1 unit), intraoperative transfusion (HR 1.5 95% CI 1.11-2.02), adjuvant chemo (HR 0.70 95% CI 0.55-0.87). For PSD patients, predictors included PCI score (HR 1.05 95% CI: 1.01-1.10 per 1 unit) and female gender (HR 0.59 95% CI: 0.39-0.91).
Conclusions: R0 resections are associated with improved outcomes and median survival is similar among patients with HM and PSD when it is achieved. Surveillance and treatment strategies that facilitate R0 resections are needed to improve results, particularly for PSD patients.
Learning Objectives:
Compare the survival outcomes of patients with colorectal hepatic metastases and peritoneal surface disease.
Recognize the impact of R0 and R1 resection status on survival outcomes of patients with colorectal hepatic metastases and peritoneal surface disease.
Summarize how this knowledge of survival outcomes impacts clinical practice and future research.
