20-year experience in liver surgery in metastatic colorectal patients, a case series study in Ukraine

Background: For the last 3 decades, the world surgical community successfully adopted different surgical strategies for colorectal cancer patients (CRC) with liver metastases (LM) however, we are still seeing the evolution of treatment guidelines. The purpose of the study was to analyze a 20-year evolution of CRC patients with LM being treated in a specialized state Ukrainian oncological center. Methods: The retrospective analysis of 1,118 CRC patient cases using prospectively collected patient data from the National Cancer Institute registry. The time ranges between 2000-2010 and 2011-2022 and the LM manifestation – metachronous (M0) / synchronous (M1) were the two main grouping criteria. Results: The OS 5-year survival of patients who had surgery between 2000-2011 and 2012-2022 was 51,3% and 58,2% (P=0,61) for the M0 cohort and 22,6% and 34,7% at M1 (P=0,002), respectively. The results of the multivariate analysis in 1,118 cases revealed that liver re-resection and regional lymph node dissection ≥ D2 were associated with better OS (HR (95% CI) = 0,76 (0,58-0,99) P=0,04) in the M0 cohort and receiving ≥15 courses of chemotherapy had better recurrence-free survival rates (HR (95% CI) = 0,97 (0,95-0,99), P=0,03) for both M0 and M1. Conclusions: It was shown the improvement of the oncological prognosis for CRC patients with synchronous LM who were treated after 2012. The adaptation of world experience algorithms and the surgical strategy evolution have become the root cause of the above.