Simultaneous Versus Delayed Resection for Initially Resectable Synchronous Colorectal Cancer Liver Metastases A Prospective, Open-label, Randomized, Controlled Trial

Karim Boudjema (1) , Clara Locher (2, 3) , Charles Sabbagh (4, 5) , Pablo Ortega-Deballon (6, 7) , Bruno Heyd (8) , Philippe Bachellier (9) , Sylvie Metairie (10) , Francois Paye (11) , Pascal Bourlier (12) , Rene Adam (13) , Aude Merdrignac (3, 14) , Christelle Tual (2) , Estelle Le Pabic (2, 3) , Laurent Sulpice (3, 14) , Bernard Meunier (15) , Jean-Marc Regimbeau (16, 5) , Eric Bellissant (2, 3)

1 Centre Hospitalier Universitaire [Rennes]
2 CIC - Centre d'Investigation Clinique [Rennes]
3 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
4 CHU Amiens-Picardie
5 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
6 LabEx LipSTIC - Laboratoire d'Excellence : Lipoprotéines et Santé : prévention et Traitement des maladies Inflammatoires et du Cancer
7 CHU Dijon
8 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
9 HUS - Les Hôpitaux Universitaires de Strasbourg
10 IMAD - Institut des maladies de l'appareil digestif [Nantes]
11 CHU Saint-Antoine [AP-HP]
12 Hôpital Trousseau
13 CHB - Centre Hépato-Biliaire [Hôpital Paul Brousse]
14 NuMeCan - Nutrition, Métabolismes et Cancer
15 Service des maladies du foie [CHU Rennes]
16 Chirurgie digestive [CHU Amiens]

Objective: To answer whether synchronous colorectal cancer liver metastases (SLM) should be resected simultaneously with primary cancer or should be delayed. Summary Background Data: Numerous studies have compared both strategies. All were retrospective and conclusions were contradictory. Methods: Adults with colorectal cancer and resectable SLM were randomly assigned to either simultaneous or delayed resection of the metastases. The primary outcome was the rate of major complications within 60 days following surgery. Secondary outcomes included overall and disease-free survival. Results: A total of 105 patients were recruited. Eighty-five patients (39 and 46 in the simultaneous- and delayed-resection groups, respectively) were analyzed. The percentage of major perioperative complications did not differ between groups (49% and 46% in the simultaneous- and delayed-resection groups, respectively, adjusted OR 0.84, 95% CI 0.35-2.01; P = 0.70, logistic regression). Complications rates were 28% and 13% (P = 0.08, chi(2) test) at colorectal site and 15% and 17% (P = 0.80, chi(2) test) at liver site, in simultaneous- and delayed-resection groups, respectively. In the delayed-resection group, 8 patients did not reach the liver resection stage, and this was due to disease progression in 6 cases. After 2 years, overall and disease-free survival tended to be improved in simultaneous as compared with delayed-resection groups (P = 0.05), a tendency which persisted for OS after a median follow-up of 47 months. Conclusions: Complication rates did not appear to differ when colorectal cancer and synchronous liver metastases are resected simultaneously. Delayed resection tended to impair overall survival.

Domaines: Sciences du Vivant [q-bio]

Karim Boudjema, Clara Locher, Charles Sabbagh, Pablo Ortega-Deballon, Bruno Heyd, et al.. Simultaneous Versus Delayed Resection for Initially Resectable Synchronous Colorectal Cancer Liver Metastases A Prospective, Open-label, Randomized, Controlled Trial. Annals of Surgery, 2021, 273 (1), pp.49-56. ⟨10.1097/SLA.0000000000003848⟩. ⟨hal-03595519⟩