Timing of Resection of Liver Metastases Synchronous to Colorectal Tumor: Proposal of Prognosis-Based Decisional Model

Institute for Cancer Research and Treatment, Torino, Piedmont, Italy
Annals of Surgical Oncology (Impact Factor: 3.93). 04/2007; 14(3):1143-50. DOI: 10.1245/s10434-006-9284-5
Source: PubMed


Timing of hepatectomy for synchronous metastases of colorectal cancer is still debated. The aim of this retrospective study was to analyze prognostic factors after synchronous and delayed liver resections to define selection criteria for choosing timing of hepatectomy.
The study was performed on 127 patients with synchronous metastases undergoing radical hepatectomy. We divided patients according to the timing of hepatectomy: 70 synchronous (group A) and 57 delayed (group B).
Overall survival was similar between the two groups (5-year survival 30.8% vs. 32.0% A vs. B, P = .406). The multivariate analysis evidenced four independent prognostic factors in group A: male sex (P = .04), T4 (P = .0035), more than three metastases (P = .0001), and metastatic infiltration of nearby structures (P < .0001). There were no statistically significant prognostic factors in group B. Patients with more than three metastases had a significantly worse survival in group A than in group B (3-year survival, 15.0% vs. 34.3%, P = .007); similarly, borderline significant difference was encountered in patients with T4 primary tumor (3-year survival, 16.7% vs. 60%, P = .064)
Patients with liver metastases synchronous with colorectal cancer with T4 primary tumor, metastasis infiltration of neighboring structures, and especially with more than three metastases should receive neoadjuvant chemotherapy before liver resection.

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    • "An added argument is the potential for increased morbidity and mortality from the combination of two major operations. However, several studies have shown that the synchronous colorectal resection does not lead to increased morbidity or mortality when combined with partial hepatectomy [27] [28] [29] [30]. There are two caveats here; the first one is the fact that most studies refer to colorectal cancer as a whole and not just rectal cancer. "
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    • "However, at present, staged resections with initial resection of the primary tumor followed by hepatic resection have been frequently performed in patients with SCLM for several reasons.4,5,9,10 First, the perioperative risk of staged resections has been thought to be less than that of simultaneous resection.4,13,14 "
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