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Comparison of treatment of patients with colorectal cancer and synchronous liver metastases by primary first-liver first approach in randomized trial
Project Id17-30015A
Main solverdoc. MUDr. Petr Vávra, Ph.D.
Period4/2017 - 12/2020
ProviderGP Min. zdravotnictví
Statesolved
AnotationThe Czech Republic leads the world in colorectal cancer (CRC) occurrence. Up to 25% of patients have synchronous colorectal liver metastases (CRCLM) at presentation and such synchronous presentation has been associated with poor survival outcomes. Surgical resection of tumors is considered the only curative therapy enabling long-term survival. Liver resection undergo less than 10% patients with synchronous CRCLM. The traditional surgical strategy is a two-stage approach that includes colorectal cancer resection followed by chemotherapy and delayed hepatic resection of the CRCLM. One disadvantage of this approach includes disease progression of CRCLM between the colorectal and hepatic surgery rendering the CRCLM unresectable. Simultaneous resection of CRC and CRCLM is burdened with higher peri-operative mortality. In the last decade the new approach aims one´s effort to improve resectability of CRCLM appears - Liver-First Approach (LFA) with chemotherapy given upfront followed by hepatic resection of CRCLM and finally CRC resection. Randomized trials, which describe LFA, are missing. Comparison between the two most frequent approaches in treatment patients with synchronous CRCLM - bowel first and liver first approach. Evaluation of long-term oncological results (disease-free interval and survival) and short-term postoperative results (30 days morbidity and mortality).
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