Treatment Allocation and Survival Outcomes in Potentially Resectable Colorectal Liver Metastases: A Real-World Cohort Study from Thailand.
4 affiliations
- 1Department of Surgery, Bhumibol Adulyadej Hospital, Bangkok 10220, Thailand.
- 2Department of Gastroenterological Surgery, School of Medicine, Fujita Health University, Bantane Hospital, Nagoya 454-8509, Aichi, Japan.
- 3Medical Oncology Unit, Department of Medicine, Bhumibol Adulyadej Hospital, Bangkok 10220, Thailand.
- 4Department of Radiology, Bhumibol Adulyadej Hospital, Bangkok 10220, Thailand.
Abstract
Background/objectives
Liver resection is a potentially curative treatment for colorectal liver metastases (CRLM), but some potentially resectable patients may not reach specialist hepatobiliary assessment. This study evaluated treatment allocation, survival outcomes, and the potential gap between resectability and actual liver resection in a real-world Thai cohort.Methods
We retrospectively reviewed 265 patients with CRLM treated at a tertiary-care hospital in Thailand between 2012 and 2022. Patients were classified into liver resection (LR; n = 57) and no liver resection (NLR; n = 208) groups. NLR patients without extrahepatic metastases were retrospectively reassessed for potential resectability by two hepatobiliary surgeons using predefined anatomical, oncological, and liver functional criteria. Baseline characteristics and overall survival (OS) were compared between LR patients and potentially resectable NLR patients. Cox regression analysis was also performed in the combined resectable cohort.Results
Median OS was 59 months in the LR group and 23 months in the NLR group. In the NLR group, age < 65 years (adjusted HR 0.663, 95% CI 0.458-0.960; p = 0.030) and absence of extrahepatic metastases (adjusted HR 0.637, 95% CI 0.417-0.973; p = 0.037) were independently associated with longer OS. Among 67 NLR patients without extrahepatic metastases, 27 (40.3%; 13.0% of all NLR patients) were considered potentially resectable. All 27 had undergone primary colorectal tumor resection but had not been referred for hepatobiliary surgical assessment. No significant differences were observed in the measured baseline characteristics between these 27 patients and the LR group. Median OS was 29 versus 59 months, respectively (log-rank p = 0.018). In the combined resectable cohort (n = 84), LR remained associated with longer OS after adjustment for timing of liver metastases, number of liver lesions, and bilobar distribution (adjusted HR 0.40, 95% CI 0.20-0.81; p = 0.011).Conclusions
A clinically relevant subgroup of non-resected patients met predefined criteria for potential resectability on retrospective specialist reassessment. These findings should be interpreted as real-world treatment-allocation observations rather than evidence of a causal survival benefit of LR and support early hepatobiliary referral and repeated multidisciplinary assessment of resectability.
Related
- A Contemporary Review of Resectability and Treatment Strategies for Colorectal Liver Metastases: Part 1—Diagnosis, Defining Resectability, and Management of Upfront Resectable and Synchronous Disease
- Cohort profile: KaroLiver, a population-based cohort of patients receiving curative liver-directed treatment for colorectal liver metastases at a Swedish tertiary centre
- A Contemporary Review of Resectability and Treatment Strategies for Colorectal Liver Metastases: Part 2-Advanced Surgical Techniques, Conversion Strategies, and the Expanding Boundaries of Treatment.
- Rethinking Surgical Margins in Colorectal Liver Metastases: Vessel-Skeletonized Parenchymal-Sparing Hepatectomy (VESPAH) and Treatment Continuity
- FOLFOX-HAIC plus regorafenib for the treatment of unresectable colorectal liver metastases refractory to first and second-line systemic chemotherapy
BibTeX
@article{jaseanchiun2026treatment,
title = {{Treatment Allocation and Survival Outcomes in Potentially Resectable Colorectal Liver Metastases: A Real-World Cohort Study from Thailand.}},
author = {Warakorn Jaseanchiun and Hiroyuki Kato and Chutima Phettool and Chanchai Suwannakij and Jadsada Athigakunagron and Setthasiri Pantanakul and Papanun Methakittrakoon and Nattapon Passawart and San Wattanasuttivong and Chaninart Liengudom and Karun Sereeborwornthanasa and Panot Yimchareon},
journal = {Cancers},
year = {2026},
month = sep,
doi = {10.3390/cancers18193096},
url = {https://europepmc.org/article/MED/42882791},
note = {CC BY},
}
RIS
TY - JOUR
TI - Treatment Allocation and Survival Outcomes in Potentially Resectable Colorectal Liver Metastases: A Real-World Cohort Study from Thailand.
AU - Warakorn Jaseanchiun
AU - Hiroyuki Kato
AU - Chutima Phettool
AU - Chanchai Suwannakij
AU - Jadsada Athigakunagron
AU - Setthasiri Pantanakul
AU - Papanun Methakittrakoon
AU - Nattapon Passawart
AU - San Wattanasuttivong
AU - Chaninart Liengudom
AU - Karun Sereeborwornthanasa
AU - Panot Yimchareon
PY - 2026
DA - 2026/09/23
JO - Cancers
DO - 10.3390/cancers18193096
UR - https://europepmc.org/article/MED/42882791
AB - Background/objectives Liver resection is a potentially curative treatment for colorectal liver metastases (CRLM), but some potentially resectable patients may not reach specialist hepatobiliary assessment. This study evaluated treatment allocation, survival outcomes, and the potential gap between resectability and actual liver resection in a real-world Thai cohort.Methods We retrospectively reviewed 265 patients with CRLM treated at a tertiary-care hospital in Thailand between 2012 and 2022. Patients were classified into liver resection (LR; n = 57) and no liver resection (NLR; n = 208) groups. NLR patients without extrahepatic metastases were retrospectively reassessed for potential resectability by two hepatobiliary surgeons using predefined anatomical, oncological, and liver functional criteria. Baseline characteristics and overall survival (OS) were compared between LR patients and potentially resectable NLR patients. Cox regression analysis was also performed in the combined resectable cohort.Results Median OS was 59 months in the LR group and 23 months in the NLR group. In the NLR group, age < 65 years (adjusted HR 0.663, 95% CI 0.458-0.960; p = 0.030) and absence of extrahepatic metastases (adjusted HR 0.637, 95% CI 0.417-0.973; p = 0.037) were independently associated with longer OS. Among 67 NLR patients without extrahepatic metastases, 27 (40.3%; 13.0% of all NLR patients) were considered potentially resectable. All 27 had undergone primary colorectal tumor resection but had not been referred for hepatobiliary surgical assessment. No significant differences were observed in the measured baseline characteristics between these 27 patients and the LR group. Median OS was 29 versus 59 months, respectively (log-rank p = 0.018). In the combined resectable cohort (n = 84), LR remained associated with longer OS after adjustment for timing of liver metastases, number of liver lesions, and bilobar distribution (adjusted HR 0.40, 95% CI 0.20-0.81; p = 0.011).Conclusions A clinically relevant subgroup of non-resected patients met predefined criteria for potential resectability on retrospective specialist reassessment. These findings should be interpreted as real-world treatment-allocation observations rather than evidence of a causal survival benefit of LR and support early hepatobiliary referral and repeated multidisciplinary assessment of resectability.
SN - 2072-6694
ER -