wetenschapsdag 2023 | 109 Best Abstract Sessie x1 Auteurs M.J.G. Bond, K. Bolhuis, K.P. de Jong, G. Kazemier, J.M. Klaase, M.S.L. Liem, A.M. Rijken, C. Verhoef, J.H.W. de Wilt, A.M. May, C.J.A. Punt, R.J. Swijnenburg Abstract titel One-stage versus two-stage surgery for initially unresectable colorectal cancer liver metastases: a propensity score-matched analysis of the Dutch CAIRO5 trial Background Considerable variability exists among liver surgeons in assessing resectability and local treatment planning of initially unresectable colorectal cancer liver-only metastases (CRLM). We analysed outcomes of one-stage versus two-stage surgery in patients with initially unresectable CRLM from the phase 3 CAIRO5 study. Methods An expert panel of surgeons and radiologists assessed resectability at baseline and 2-monthly thereafter. If surgeons judged CRLM as resectable, detailed local treatment plans were provided. Propensity score matching was used to compare two-stage with one-stage surgery, and two-stage surgery with no local treatment. Matching was based on age, sex, number, distribution, and size of CRLM, number of involved liver segments, RAS/BRAFV600E mutation status, primary tumour location, synchronous/metachronous CRLM, performance status, CEA, LDH, and best response. Results One-stage versus two-stage surgery was compared in a matched sample of 160 patients. Median age was 61 versus 62, median number of CRLM 10 versus 9, and 94% versus 95% had bilobar CRLM. Median overall survival (OS) was 43.6 versus 31.7 months (HR 0.54, 95%CI 0.36-0.81, p=0.002) with one-stage versus twostage surgery. Clavien Dindo grade >_3 complications occurred in 16 (20%) versus 18 (22%) patients (p=0.85), portal vein embolisation was performed in 8 (10%) versus 60 (75%) patients (p<0.001), and local treatment was complete (R0/R1 resection or ablation of all CRLM) in 74 (92%) versus 56 (70%) patients (p<0.001), in whom 45 (61%) versus 24 (43%) ablation was performed, in one-stage versus two-stage surgery, respectively. In a matched sample of 146 patients, median OS was 33.4 versus 21.5 months (HR 0.48, 95%CI 0.33-0.70, p<0.001) with two-stage surgery versus no local treatment. Conclusion When technically feasible, one-stage surgery +/- ablation seems the preferred approach for patients with initially unresectable CRLM. If one-stage surgery is not feasible, two-stage hepatectomy leads to longer survival then no local treatment.
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