• Axel Andres, Christian Toso, Rene Adam, Eduardo Barroso, Catherine Hubert, Lorenzo Capussotti, Eric Gerstel, Arnaud Roth, Pietro E Majno, and Gilles Mentha.
• Abdominal and Transplantation Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland.
• Ann. Surg.. 2012 Nov 1;256(5):772-8; discussion 778-9.

BackgroundLiver-first reversed management (RM) for the treatment of patients with simultaneous colorectal liver metastases (CRLM) includes liver-directed chemotherapy, the resection of the CRLM, and the subsequent resection of the primary cancer. Retrospective data have shown that up to 80% of patients can successfully undergo a complete RM, whereas less than 30% of those undergoing classical management (CM) do so. This registry-based study compared the 2 approaches.MethodsThe study was based on the LiverMetSurvey (January 1, 2000 to December 31, 2010) and included patients with 2 or more metastases. All patients had irinotecan and/or oxaliplatin-based chemotherapy before liver surgery. Patients undergoing simultaneous liver and colorectal surgery were excluded.ResultsA total of 787 patients were included: 729 in the CM group and 58 in the RM group. Patients in the 2 groups had similar numbers of metastases (4.20 vs 4.80 for RM and CM, P = 0.231) and Fong scores of 3 or more (79% vs 87%, P = 0.164). Rectal cancer, neoadjuvant rectal radiotherapy, and the use of combined irinotecan/oxaliplatin chemotherapy were more frequent in the RM group (P < 0.001), whereas colorectal lymph node involvement was more frequent in the CM group (P < 0.001). Overall survival and disease-free survival were similar in the RM and CM groups (48% vs 46% at 5 years, P = 0.965 and 30% vs 26%, P = 0.992).ConclusionsClassical and reversed managements of metastatic liver disease in colorectal cancer are associated with similar survival when successfully completed.

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