• Georgios Antonios Margonis, Jaeyun Jane Wang, Thomas Boerner, Roberto Moretto, Stefan Buettner, Nikolaos Andreatos, Johan Gagnière, Doris Wagner, Inger Marie Løes, Francesca Bergamo, Filippo Pietrantonio, Mario Scartozzi, Andrea Spallanzani, Bruno Vincenzi, Efstathios Antoniou, Emmanouil Pikoulis, Andrea Sartore-Bianchi, Georgios Stasinos, Kazunari Sasaki, Timothy M Pawlik, Armando Orlandi, Nicoletta Pella, Fabian Fitschek, Klaus Kaczirek, Aurélien Dupré, Ioannis Pozios, Katharina Beyer, Peter Kornprat, Federico N Aucejo, Richard Burkhart, Matthew J Weiss, Per Eystein Lønning, George Poultsides, Chiara Cremolini, Martin E Kreis, and Michael D'Angelica.
• Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
• Br J Surg. 2024 Jul 2; 111 (7).

BackgroundTo date, only two studies have compared the outcomes of patients with liver-limited BRAF V600E-mutated colorectal liver metastases (CRLMs) managed with resection versus systemic therapy alone, and these have reported contradictory findings.MethodsIn this observational, international, multicentre study, patients with liver-limited BRAF V600E-mutated CRLMs treated with resection or systemic therapy alone were identified from institutional databases. Patterns of recurrence/progression and overall survival were compared using multivariable analyses of the entire cohort and a propensity score-matched cohort.ResultsOf 170 patients included, 119 underwent hepatectomy and 51 received systemic treatment. Surgically treated patients had a more favourable pattern of recurrence with most recurrences limited to a single site, whereas diffuse progression was more common among patients who received systemic treatment (19 versus 44%; P = 0.002). Surgically treated patients had longer median overall survival (35 versus 20 months; P < 0.001). Hepatectomy was independently associated with better OS than systemic treatment alone (HR 0.37, 95% c.i. 0.21 to 0.65). In the propensity score-matched cohort, surgically treated patients had longer median overall survival (28 versus 20 months; P < 0.001); hepatectomy was independently associated with better overall survival (HR 0.47, 0.25 to 0.88).ConclusionBRAF V600E mutation should not be considered a contraindication to surgery for patients with resectable, liver-only CRLMs.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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