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Collienne M, Neven A, Caballero C, Kataoka K, Carrion-Alvarez L, Nilsson H, Désolneux G, Rivoire M, Ruers T, Gruenberger T, Protic M, Troisi RI, Primavesi F, Staettner S, Rahbari N, Schnitzbauer A, Malik H, Swijnenburg RJ, Mauer M, Ducreux M, Evrard S. EORTC 1409 GITCG/ESSO 01 - A prospective colorectal liver metastasis database for borderline or initially unresectable diseases (CLIMB): Lessons learnt from real life. From paradigm to unmet need. Eur J Surg Oncol 2023; 49:107081. [PMID: 37793303 DOI: 10.1016/j.ejso.2023.107081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023]
Abstract
AIM Multidisciplinary management of metastatic colorectal liver metastases (CRLM) is still challenging. To assess postoperative complications in initially unresectable or borderline resectable CRLM, the prospective EORTC-1409 ESSO 01-CLIMB trial capturing 'real-life data' of European centres specialized in liver surgery was initiated. MATERIAL AND METHODS A total of 219 patients were registered between May 2015 and January 2019 from 15 centres in nine countries. Eligible patients had borderline or initially unresectable CRLM assessed by pre-operative multidisciplinary team discussion (MDT). Primary endpoints were postoperative complications, 30-day and 90-days mortality post-surgery, and quality indicators. We report the final results of the 151 eligible patients that underwent at least one liver surgery. RESULTS Perioperative chemotherapy with or without targeted treatment were administered in 100 patients (69.4%). One stage resection (OSR) was performed in 119 patients (78.8%). Two stage resections (TSR, incl. Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy (ALPPS)) were completed in 24 out of 32 patients (75%). Postoperative complications were reported in 55.5% (95% CI: 46.1-64.6%), 64.0% (95% CI: 42.5-82%), and 100% (95% CI: 59-100%) of the patients in OSR, TSR and ALPPS, respectively. Post-hepatectomy liver failure occurred in 6.7%, 20.0%, and 28.6% in OSR, TSR, and ALPPS, respectively. In total, four patients (2.6%) died after surgery. CONCLUSION Across nine countries, OSR was more often performed than TSR and tended to result in less postoperative complications. Despite many efforts to register patients across Europe, it is still challenging to set up a prospective CRLM database.
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Affiliation(s)
- Maike Collienne
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
| | - Anouk Neven
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Luxembourg Institute of Health, Competence Center for Methodology and Statistics, Strassen, Luxembourg
| | | | - Kozo Kataoka
- Division of Lower GI, Department of Gastroenterological Surgery, School of Medicine, Hyogo Medical University, Hyogo, Japan
| | | | - Henrik Nilsson
- Karolinska Institutet, Department of Clinical Sciences Danderyd, Stockholm, Sweden
| | | | | | - Theo Ruers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Thomas Gruenberger
- Clinic Favoriten, HPB Center, Health Network Vienna and Sigmund Freud University, Vienna, Austria
| | - Mladjan Protic
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia and Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Roberto Ivan Troisi
- Dept. of Human Structure and Repair, Ghent University, Belgium; Division of HPB, Minimally Invasive and Robotic Surgery, Renal Transplantation Service, Dept. of Clinical Medicine and Surgery, Federico II University Hospital Naples, Italy
| | - Florian Primavesi
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum, Austria
| | - Stefan Staettner
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum, Austria
| | - Nuh Rahbari
- Department of Surgery, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Andreas Schnitzbauer
- Universitätsklinikum Frankfurt Goethe-Universität Frankfurt Am Main Klinik für Allgemein- und Viszeralchirurgie, Frankfurt, Germany
| | - Hassan Malik
- Aintree University Hospital NHS Trust, Liverpool, United Kingdom
| | - Rutger-Jan Swijnenburg
- Leiden University Medical Center, Leiden, Netherlands; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Murielle Mauer
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Michel Ducreux
- Gustave Roussy, Université Paris Saclay, Inserm, U1279, France
| | - Serge Evrard
- Institut Bergonié, Université de Bordeaux, INSERM, U1312, France.
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