Two Decades of Multimodal Management of Colorectal Liver Metastases With Long-Term Outcomes

Abstract

The management of patients with colorectal liver metastases (CRLM) is complex and requires a tailored approach based on disease extent, patient age, and comorbidities. Given the heterogeneity in presentation and evolving treatment algorithms, prognostic factors for long-term survival following liver resection are contested. This study aimed to evaluate "real-world" outcomes in patients with long-term follow-up after potentially curative liver resection at a tertiary Australian center. A retrospective analysis was conducted on prospectively collected data from patients who underwent first-time liver resection for CRLM between 1998 and 2018. Standardized clinical, biochemical, and radiological follow-up was undertaken. Multivariable Cox regression analysis was used to identify independent predictors of overall survival (OS), measured from the diagnosis of liver metastases to death or last contact. Of 396 patients who underwent resection, 320 met the inclusion criteria. The median follow-up was 123.3 months (95% CI: 110.5-131.0), median OS was 69.6 months (95% CI: 57.2-84.5), and the 10-year OS rate was 33%; 5-year and 10-year disease-free survival rates were 29% and 25%, respectively. Neoadjuvant chemotherapy was administered in 72% of patients, with 25% receiving targeted therapy in this setting. Postoperative (adjuvant or recurrence-related) chemotherapy was given to 50% of patients, with 17% also receiving targeted therapy. Independent predictors of poor OS included older age, right-sided primary tumours, large liver tumours, administration of locoregional liver therapy, and the use of chemotherapy ± targeted therapy in both the neoadjuvant and adjuvant settings. One-third of patients who undergo liver resection for CRLM achieve long-term survival. While multi-modal therapy was commonly used, determining the specific contribution of non-surgical treatments is challenging in a real-world cohort where treatment paradigms evolved over time. This study provides rare 10-year follow-up data and reinforces the need for ongoing refinement of personalised management strategies for CRLM.