Introduction: Resection of colorectal liver metastasis has emerged as the standard treatment. Our study compares oncological outcomes of patients with resected synchronous bilobar versus unilobar colorectal liver metastasis. Methods: This retrospective study presents long-term follow-up data of 105 consecutive patients with primary colorectal cancer and synchronous liver metastasis. All patients underwent primary tumor and metastasis resections between 2007 and 2019. Results: Fifty-five patients with bilobar and 50 patients with unilobar colorectal liver metastases were included. No significant difference in overall, tumor-specific, or recurrence-free survival was observed between patients with bilobar and unilobar metastases. After case-control matching, the results were confirmed in patients with similar tumor burdens. In the multivariate analysis, chemotherapy following liver metastasis resection was a significant prognostic factor associated with improved overall survival (hazard ratio 0.518, 95% confidence interval: 0.302–0.888, p = 0.017). Conclusion: Overall survival, as well as tumor-specific and recurrence-free survival, did not differ between patients with unilobar and bilobar liver metastasis. These findings contribute to the understanding that primary tumor and metastasis resection in eligible patients improve long-term outcomes.

1.
Sung
H
,
Ferlay
J
,
Siegel
RL
,
Laversanne
M
,
Soerjomataram
I
,
Jemal
A
, et al
.
Global cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries
.
CA Cancer J Clin
.
2021
;
71
(
3
):
209
49
.
2.
AWMF, Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF)
.
S3-Leitlinie kolorektales karzinom
.
2019
. Registrierungsnummer: 021/007OL http://www.leitlinienprogrammonkologie.de/leitlinien/kolorektales-karzinom Langversion 2.1[abgerufen am: TT.MM.JJJJ.
3.
Jones
RP
,
Vauthey
JN
,
Adam
R
,
Rees
M
,
Berry
D
,
Jackson
R
, et al
.
Effect of specialist decision-making on treatment strategies for colorectal liver metastases
.
Br J Surg
.
2012
;
99
(
9
):
1263
9
.
4.
Fong
Y
,
Fortner
J
,
Sun
RL
,
Brennan
MF
,
Blumgart
LH
.
Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1,001 consecutive cases
.
Ann Surg
.
1999
;
230
(
3
):
309
21
; discussion 318-21.
5.
Gayowski
TJ
,
Iwatsuki
S
,
Madariaga
JR
,
Selby
R
,
Todo
S
,
Irish
W
, et al
.
Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathologic risk factors
.
Surgery
.
1994
;
116
(
4
):
703
11
; discussion 710-1.
6.
Wanebo
HJ
,
Chu
QD
,
Vezeridis
MP
,
Soderberg
C
.
Patient selection for hepatic resection of colorectal metastases
.
Arch Surg
.
1996
;
131
(
3
):
322
9
.
7.
Sakamoto
Y
,
Fujita
S
,
Akasu
T
,
Nara
S
,
Esaki
M
,
Shimada
K
, et al
.
Is surgical resection justified for stage IV colorectal cancer patients having bilobar hepatic metastases?--an analysis of survival of 77 patients undergoing hepatectomy
.
J Surg Oncol
.
2010
;
102
(
7
):
784
8
.
8.
Sorbye
H
,
Mauer
M
,
Gruenberger
T
,
Glimelius
B
,
Poston
GJ
,
Schlag
PM
, et al
.
Predictive factors for the benefit of perioperative FOLFOX for resectable liver metastasis in colorectal cancer patients (EORTC Intergroup Trial 40983)
.
Ann Surg
.
2012
;
255
(
3
):
534
9
.
9.
Fukami
Y
,
Kaneoka
Y
,
Maeda
A
,
Takayama
Y
,
Takahashi
T
,
Onoe
S
, et al
.
Bilobar versus unilobar multiple colorectal liver metastases: a propensity score analysis of surgical outcomes and recurrence patterns
.
J Hepatobiliary Pancreat Sci
.
2017
;
24
(
3
):
153
60
.
10.
Cady
B
,
Jenkins
RL
,
Steele
GD
Jr
,
Lewis
WD
,
Stone
MD
,
McDermott
WV
, et al
.
Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome
.
Ann Surg
.
1998
;
227
(
4
):
566
71
.
11.
Elias
D
,
Cavalcanti
A
,
Sabourin
JC
,
Pignon
JP
,
Ducreux
M
,
Lasser
P
.
Results of 136 curative hepatectomies with a safety margin of less than 10 mm for colorectal metastases
.
J Surg Oncol
.
1998
;
69
(
2
):
88
93
.
12.
Homayounfar
K
,
Bleckmann
A
,
Conradi
LC
,
Sprenger
T
,
Beissbarth
T
,
Lorf
T
, et al
.
Bilobar spreading of colorectal liver metastases does not significantly affect survival after R0 resection in the era of interdisciplinary multimodal treatment
.
Int J Colorectal Dis
.
2012
;
27
(
10
):
1359
67
.
13.
Minagawa
M
,
Makuuchi
M
,
Torzilli
G
,
Takayama
T
,
Kawasaki
S
,
Kosuge
T
, et al
.
Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results
.
Ann Surg
.
2000
;
231
(
4
):
487
99
.
14.
Giuliante
F
,
Viganò
L
,
De Rose
AM
,
Mirza
DF
,
Lapointe
R
,
Kaiser
G
, et al
.
Liver-first approach for synchronous colorectal metastases: analysis of 7,360 patients from the LiverMetSurvey registry
.
Ann Surg Oncol
.
2021
;
28
(
13
):
8198
208
.
15.
Sasaki
K
,
Morioka
D
,
Conci
S
,
Margonis
GA
,
Sawada
Y
,
Ruzzenente
A
, et al
.
The tumor burden score: a new “Metro-ticket” prognostic tool for colorectal liver metastases based on tumor size and number of tumors
.
Ann Surg
.
2018
;
267
(
1
):
132
41
.
16.
Couinaud
C
.
The Liver: anatomical and surgical studies
.
Paris
:
Messon
;
1957
; p.
235
8
.
17.
Wasan
HS
,
Gibbs
P
,
Sharma
NK
,
Taieb
J
,
Heinemann
V
,
Ricke
J
, et al
.
First-line selective internal radiotherapy plus chemotherapy versus chemotherapy alone in patients with liver metastases from colorectal cancer (FOXFIRE, SIRFLOX, and FOXFIRE-Global): a combined analysis of three multicentre, randomised, phase 3 trials
.
Lancet Oncol
.
2017
;
18
(
9
):
1159
71
.
18.
Allard
MA
,
Adam
R
,
Giuliante
F
,
Lapointe
R
,
Hubert
C
,
Ijzermans
JNM
, et al
.
Long-term outcomes of patients with 10 or more colorectal liver metastases
.
Br J Cancer
.
2017
;
117
(
5
):
604
11
.
19.
Mitry
E
,
Fields
ALA
,
Bleiberg
H
,
Labianca
R
,
Portier
G
,
Tu
D
, et al
.
Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials
.
J Clin Oncol
.
2008
;
26
(
30
):
4906
11
.
20.
Dixon
MEB
,
Gusani
NJ
.
Bilobar colorectal liver metastases: challenges and opportunities
.
Ann Surg Oncol
.
2021
;
28
(
3
):
1268
70
.
21.
Faitot
F
,
Faron
M
,
Adam
R
,
Elias
D
,
Cimino
M
,
Cherqui
D
, et al
.
Two-stage hepatectomy versus 1-stage resection combined with radiofrequency for bilobar colorectal metastases: a case-matched analysis of surgical and oncological outcomes
.
Ann Surg
.
2014
;
260
(
5
):
822
8
; discussion 827-8.
22.
Morris
VK
,
Kennedy
EB
,
Baxter
NN
,
Benson
AB
3rd
,
Cercek
A
,
Cho
M
, et al
.
Treatment of metastatic colorectal cancer: ASCO guideline
.
J Clin Oncol
.
2023
;
41
(
3
):
678
700
.
23.
Nordlinger
B
,
Sorbye
H
,
Glimelius
B
,
Poston
GJ
,
Schlag
PM
,
Rougier
P
, et al
.
Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial
.
Lancet
.
2008
;
371
(
9617
):
1007
16
.
24.
Conrad
C
,
You
N
,
Vauthey
JN
.
In patients with colorectal liver metastases, can we still rely on number to define treatment and outcome
.
Oncol
.
2013
;
27
(
11
):
83
1086
.
25.
Altendorf-Hofmann
A
,
Scheele
J
.
A critical review of the major indicators of prognosis after resection of hepatic metastases from colorectal carcinoma
.
Surg Oncol Clin N Am
.
2003
;
12
(
1
):
165
92
.
26.
Oshi
M
,
Margonis
GA
,
Sawada
Y
,
Andreatos
N
,
He
J
,
Kumamoto
T
, et al
.
Higher tumor burden neutralizes negative margin status in hepatectomy for colorectal cancer liver metastasis
.
Ann Surg Oncol
.
2019
;
26
(
2
):
593
603
.
You do not currently have access to this content.