{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:02:21Z","timestamp":1760144541676,"version":"build-2065373602"},"reference-count":44,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T00:00:00Z","timestamp":1714089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Asociaci\u00f3n Espa\u00f1ola de Cirujanos","award":["Research Projects 2020"],"award-info":[{"award-number":["Research Projects 2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>(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 &lt;50 hepatectomies\/year. The proportion of patients as ASA III was significantly higher in centers performing \u226550 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 &lt;50 and \u226550 hepatectomies\/year. Further analysis evaluating factors associated with clinical outcomes and determining the best candidates for this approach will be subsequently conducted.<\/jats:p>","DOI":"10.3390\/cancers16091676","type":"journal-article","created":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T05:13:41Z","timestamp":1714108421000},"page":"1676","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility and Short-Term Outcomes in Liver-First Approach: A Spanish Snapshot Study (the RENACI Project)"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2466-0711","authenticated-orcid":false,"given":"Mario","family":"Serradilla-Mart\u00edn","sequence":"first","affiliation":[{"name":"Department of Surgery, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria ibs.GRANADA, 18012 Granada, Spain"},{"name":"Department of Surgery, School of Medicine, University of Granada, 18016 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celia","family":"Villodre","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital General Universitario Dr. Balmis, 03010 Alicante, Spain"},{"name":"ISABIAL, Instituto de Investigaci\u00f3n Sanitaria y Biom\u00e9dica de Alicante, 03010 Alicante, Spain"},{"name":"Department of Surgery, Universidad Miguel Hern\u00e1ndez, 03202 Alicante, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laia","family":"Falgueras-Verdaguer","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Dr. Josep Trueta, 17007 Girona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalia","family":"Zambudio-Carroll","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 T.","family":"Castell-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan L.","family":"Blas-Laina","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Royo Villanova, 50015 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicente","family":"Borrego-Estella","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Lozano Blesa, 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Domingo-del-Pozo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Dr. Peset, 46017 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Garc\u00eda-Plaza","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Insular, 35016 Las Palmas de Gran Canaria, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco J.","family":"Gonz\u00e1lez-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Cl\u00ednico Universitario de Santiago, 15706 Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva M.","family":"Montalv\u00e1-Or\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario y Polit\u00e9cnico La Fe, IIS La Fe, Ciberehd ISCIII, 46026 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1ngel","family":"Moya-Herraiz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario de Castell\u00f3n, 12004 Castell\u00f3 de la Plana, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Paterna-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel A.","family":"Su\u00e1rez-Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Virgen de la Victoria, 29010 M\u00e1laga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maialen","family":"Alkorta-Zuloaga","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Donostia, 20014 San Sebasti\u00e1n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4845-5306","authenticated-orcid":false,"given":"Gerardo","family":"Blanco-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario de Badajoz, 06006 Badajoz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrique","family":"Dab\u00e1n-Collado","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario San Cecilio, 18016 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel A.","family":"G\u00f3mez-Bravo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Virgen del Roc\u00edo, 41013 Sevilla, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 I.","family":"Miota-de-Llamas","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario de Albacete, 02006 Albacete, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Rotellar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Belinda","family":"S\u00e1nchez-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Regional Universitario de M\u00e1laga, 29010 M\u00e1laga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santiago","family":"S\u00e1nchez-Cab\u00fas","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario de la Santa Creu i Sant Pau, 08041 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Pacheco-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario R\u00edo Hortega, 47012 Valladolid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan C.","family":"Rodr\u00edguez-Sanjuan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda A.","family":"Varona-Bosque","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Nuestra Se\u00f1ora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2301-2795","authenticated-orcid":false,"given":"Luc\u00eda","family":"Carri\u00f3n-\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sof\u00eda","family":"de la Serna-Esteban","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Cl\u00ednico Universitario, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Dopazo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Mart\u00edn-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario La Princesa, 28006 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Mart\u00ednez-Cecilia","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario La Princesa, 28006 Madrid, Spain"},{"name":"Department of Surgery, Hospital Universitario Virgen de la Salud, 45004 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda J.","family":"Castro-Santiago","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Puerta del Mar, 11009 C\u00e1diz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitri","family":"Dorcaratto","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Cl\u00ednico Universitario, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta L.","family":"Guti\u00e9rrez-D\u00edaz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Quir\u00f3n, 50006 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7533-5513","authenticated-orcid":false,"given":"Jos\u00e9 M.","family":"Asencio-Pascual","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Burd\u00edo-Pinilla","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Carracedo-Iglesias","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario \u00c1lvaro Cunqueiro, 36312 Vigo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfredo","family":"Escart\u00edn-Arias","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario Arnau de Vilanova, 25198 Lleida, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedetto","family":"Ielpo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario del Mar, 08003 Barcelona, Spain"},{"name":"Department of Surgery, Hospital Universitario de Le\u00f3n, 24008 Le\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gonzalo","family":"Rodr\u00edguez-Laiz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital General Universitario Dr. Balmis, 03010 Alicante, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2614-3670","authenticated-orcid":false,"given":"Andr\u00e9s","family":"Valdivieso-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario de Cruces, 48903 Barakaldo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilio","family":"De-Vicente-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario HM Sanchinarro, 28050 Madrid, 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