(1) Background: The liver-first approach may be indicated for colorectal cancer patients with synchronous liver metastases to whom preoperative chemotherapy opens a potential window in which liver resection may be undertaken. This study aims to present the data of feasibility and short-term outcomes in the liver-first approach. (2) Methods: A prospective observational study was performed in Spanish hospitals that had a medium/high-volume of HPB surgeries from 1 June 2019 to 31 August 2020. (3) Results: In total, 40 hospitals participated, including a total of 2288 hepatectomies, 1350 for colorectal liver metastases, 150 of them (11.1%) using the liver-first approach, 63 (42.0%) in hospitals performing <50 hepatectomies/year. The proportion of patients as ASA III was significantly higher in centers performing ≥50 hepatectomies/year (difference: 18.9%;p= 0.0213). In 81.1% of the cases, the primary tumor was in the rectum or sigmoid colon. In total, 40% of the patients underwent major hepatectomies. The surgical approach was open surgery in 87 (58.0%) patients. Resection margins were R0 in 78.5% of the patients. In total, 40 (26.7%) patients had complications after the liver resection and 36 (27.3%) had complications after the primary resection. One-hundred and thirty-two (89.3%) patients completed the therapeutic regime. (4) Conclusions: There were no differences in the surgical outcomes between the centers performing <50 and ≥50 hepatectomies/year. Further analysis evaluating factors associated with clinical outcomes and determining the best candidates for this approach will be subsequently conducted.
（1）背景：对于伴有同步性肝转移的结直肠癌患者，术前化疗可能为肝切除术创造潜在窗口期，此时可考虑采用肝脏优先策略。本研究旨在呈现肝脏优先策略的可行性数据及短期疗效。（2）方法：于2019年6月1日至2020年8月31日期间，在西班牙肝胆胰手术量达中/高水平的医院开展前瞻性观察研究。（3）结果：共40家医院参与研究，累计完成2288例肝切除术，其中1350例为结直肠癌肝转移患者，采用肝脏优先策略者150例（占11.1%），其中63例（42.0%）来自年肝切除量<50例的医院。年肝切除量≥50例的中心中ASA III级患者比例显著更高（差异：18.9%；p=0.0213）。81.1%的病例原发肿瘤位于直肠或乙状结肠。总计40%患者接受大范围肝切除术。87例（58.0%）采用开放手术。78.5%患者获得R0切除。肝切除术后40例（26.7%）发生并发症，原发灶切除术后36例（27.3%）出现并发症。132例（89.3%）患者完成全程治疗方案。（4）结论：年肝切除量<50例与≥50例的医疗中心在外科结局方面无显著差异。后续将开展进一步分析，评估与临床结局相关的因素，并确定该策略的最佳适用人群。
肿瘤(癌症)患者之家