Simultaneous versus staged liver resection of synchronous liver metastases from colorectal cancer

Department of General, Visceral and Transplant Surgery, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.
International Journal of Colorectal Disease (Impact Factor: 2.45). 10/2007; 22(10):1269-76. DOI: 10.1007/s00384-007-0286-y
Source: PubMed


The surgical strategy for treatment of synchronous liver metastases from colorectal cancer remains controversial. This retrospective analysis was conducted to compare the postoperative outcome and survival of patients receiving simultaneous resection of liver metastases and primary colorectal cancer to those receiving staged resection.
Between January 1988 and September 2005, 219 patients underwent liver resection for synchronous colorectal liver metastases, of whom, 40 patients received simultaneous resection of liver metastases and primary colorectal cancer, and 179 patients staged resections. Patients were identified from a prospective database, and records were retrospectively reviewed. Patient, tumor, and operative parameters were analyzed for their influence on postoperative morbidity and mortality as well as on long-term survival.
Simultaneous liver resections tend to be performed for colon primaries rather than for rectal cancer (p = 0.004) and used less extensive liver resections (p < 0.001). The postoperative morbidity was comparable between both groups, whereas the mortality was significantly higher in patients with simultaneous liver resection (p = 0.012). The mortality after simultaneous liver resection (n = 4) occurred after major hepatectomies, and three of these four patients were 70 years of age or older. There was no significant difference in long-term survival after formally curative simultaneous and staged liver resection.
Simultaneous liver and colorectal resection is as efficient as staged resections in the treatment of patients with colorectal cancer and synchronous liver metastases. To perform simultaneous resections safely a careful patient selection is necessary. The most important criteria to select patients for simultaneous liver resection are age of the patient and extent of liver resection.

Download full-text


Available from: Antonino Spinelli, Dec 02, 2014
  • Source
    • "In the context of HMPA, surgery—whether curative or palliative—is still discussed controversially. In other fields of oncological surgery, most commonly in colorectal cancers or neuroendocrine tumors, but also in nontraditional tumors as sarcoma, melanoma, and squamous cell carcinoma hepatic resection of metastases provide a clear survival benefit [14, 25–28]. Experience with liver resection of hepatic metastases from pancreatic adenocarcinoma is limited to a few patients only though. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Backround. Pancreas resection is the only curative treatment for pancreatic adenocarcinoma. In the event of unexpected incidental liver metastases during operative exploration patients were traditionally referred to palliative treatment arms. With continuous progress in the surgical expertise simultaneous pancreas and liver resections seem technically feasible nowadays. The aim of this study therefore was to analyze the impact of synchronous liver-directed therapy on operative outcome and overall survival in patients with hepatic metastasized pancreatic adenocarcinoma (HMPA). Methods. 22 patients who underwent simultaneous pancreas resection and liver-directed therapy for HMPA between January 1, 2004 and January 1, 2009 were compared to 22 patients who underwent classic pancreas resection for nonmetastasized pancreatic adenocarcinoma (NMPA) in a matched pair study design. Postoperative morbidity, preoperative, and operative data and overall survival were analyzed. Results. Overall survival was significantly decreased in the HMPA group. Postoperative morbidity and mortality and median operation time did not significantly differ between the groups. Conclusion. The results of our study showed that simultaneous pancreas resection and liver-directed therapy may safely be performed and may therefore be applied in individual patients with HMPA. However, a potential benefit of this radical surgical approach with regard to overall survival and/or quality of life remains to be proven.
    Full-text · Article · Nov 2012 · Gastroenterology Research and Practice
  • Source
    • "Sheele et al. reported 13 anastomotic leakages of 90 simultaneous procedures in their series, and two of them led to death.4 Thelen et al. proposed the criteria for simultaneous liver resection according to the age and extent of liver resection, because death after simultaneous liver resection (n = 4) occurred after major hepatectomies, and three of these four patients were 70 years of age or older.15 Second, staged resections might offer a chance to evaluate liver or extrahepatic metastases between the two operations. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The optimal surgical strategy for resectable, synchronous, colorectal liver metastases remains unclear. The objective of this study was to determine which patients could benefit from staged resections instead of simultaneous resection by identifying predictive factors for postoperative morbidity and anastomotic leakage after simultaneous resection of synchronous, colorectal liver metastases and the primary colorectal tumor. This study involved 86 patients with synchronous colorectal liver metastases who underwent simultaneous resection of the primary colorectal tumor and the hepatic tumor. Postoperative mortality, morbidity, and other surgical outcomes, including survival and hospitalization, were assessed. Predictive factors for postoperative morbidity and for anastomotic leakage were evaluated. Postoperative morbidity and anastomotic leakage were found in 55 (64%) and 18 (21%) patients. Predictive factors for postoperative morbidity and for anastomotic leakage were intraoperative blood loss and operation time >8 h, respectively. The overall 5-year survival rate was 45%. The frequency of morbidity and that of anastomotic leakage seemed to be high after simultaneous resection for synchronous colorectal liver metastases, especially when intraoperative blood loss or operation time increased greatly. Staged resections should be considered in cases in which excessive surgical stress from simultaneous resection of synchronous colorectal liver metastases would be expected.
    Preview · Article · Nov 2011 · Journal of Gastrointestinal Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Focal liver lesions are being increasingly identified due to the widespread use of imaging modalities such as ultrasonography, computed tomography and magnetic resonance imaging that facilitate differentiation between a wide spectrum of benign and malignant liver tumours. Once the patient is referred to the surgeon, the decision not only of “when” to operate but also of “how” to operate is to be made. This review focuses on the decision making and surgery planning according to the different potential origin of a focal liver lesion. KeywordsFocal liver lesion-Liver metastasis-Liver tumor-Liver surgery-Hepatectomy-Focal nodular hyperplasia-Liver adenoma-Haemangioma-Colorectal liver metastases-Non colorectal metastases
    No preview · Article · Oct 2010 · Hellēnikē cheirourgikē. Acta chirurgica Hellenica
Show more