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The Role of KRAS Status Among Patients Undergoing Staged Versus Simultaneous Resection for Synchronous Colorectal Liver Metastases.

The Role of KRAS Status Among Patients Undergoing Staged Versus Simultaneous Resection for Synchronous Colorectal Liver Metastases. Journal of surgical oncology Baldo, A., Chatzipanagiotou, O. P., Kawashima, J., Spolverato, G., Ruzzenente, A., Poultsides, G. A., Sasaki, K., Endo, I., Kitago, M., Aucejo, F., Popescu, I., Hugh, T., Bhimani, N., Weiss, M., Gholami, S., He, J., Aldrighetti, L., Pawlik, T. M. 2025

Abstract

This study aimed to evaluate the impact of surgical timing-simultaneous versus staged resection-on outcomes of patients with colorectal liver metastases (CRLM) in relation to KRAS mutation status, which is a key factor affecting prognosis.Patients who underwent curative-intent resection for synchronous CRLM (sCRLM) were identified from an international, multi-institutional database. The association between clinicopathologic factors, staged versus simultaneous approach and wild-type (wtKRAS) versus mutated (mtKRAS) KRAS with long-term outcomes was assessed.Among 385 patients who underwent curative-intent resection for sCRLM, 205 (53.2%) individuals underwent a simultaneous primary tumor and CRLM resection; 180 (46.8%) individuals underwent a staged surgical approach. On multivariable analysis, the staged approach remained associated with improved OS compared with the simultaneous approach among patients who had mtKRAS CRLM (HR: 0.62, 95% CI: 0.39-0.99). Patients with mtKRAS and high TBS demonstrated an improved 5-year OS (67.0%, 95% CI: 54.2%-83.0% vs. 47.5%, 95% CI: 31.4%, 71.9%; p?=?0.04) compared with a simultaneous procedure. There was no difference in OS among patients with either wtKRAS or mtKRAS and low TBS who underwent staged versus simultaneous resection (p?>?0.05).Patients with sCRLM and an aggressive tumor biology as defined by KRAS status and TBS may benefit from a two-stage resection which may improve patient selection relative to achieving better long-term outcomes.

View details for DOI 10.1002/jso.70040

View details for PubMedID 40650541