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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2007

01-12-2007 | Gastrointestinal Oncology

Simultaneous Resections of Colorectal Cancer and Synchronous Liver Metastases: A Multi-institutional Analysis

Authors: Srinevas K. Reddy, MD, Timothy M. Pawlik, MD, MPH, Daria Zorzi, MD, Ana L. Gleisner, MD, Dario Ribero, MD, Lia Assumpcao, MD, Andrew S. Barbas, BS, Eddie K. Abdalla, MD, Michael A. Choti, MD, Jean-Nicolas Vauthey, MD, Kirk A. Ludwig, MD, Christopher R. Mantyh, MD, Michael A. Morse, MD, Bryan M. Clary, MD

Published in: Annals of Surgical Oncology | Issue 12/2007

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Abstract

Background

The safety of simultaneous resections of colorectal cancer and synchronous liver metastases (SCRLM) is not established. This multi-institutional retrospective study compared postoperative outcomes after simultaneous and staged colorectal and hepatic resections.

Methods

Clinicopathologic data, treatments, and postoperative outcomes from patients who underwent simultaneous or staged colorectal and hepatic resections at three hepatobiliary centers from 1985–2006 were reviewed.

Results

610 patients underwent simultaneous (n = 135) or staged (n = 475) resections of colorectal cancer and SCRLM. Seventy staged patients underwent colorectal and hepatic resections at the same institution. Simultaneous patients had fewer (median 1 versus 2) and smaller (median 2.5 versus 3.5 cm) metastases and less often underwent major (≥ three segments) hepatectomy (26.7% versus 61.3%, p < 0.05). Combined hospital stay was lower after simultaneous resections (median 8.5 versus 14 days, p < 0.0001). Mortality (1.0% versus 0.5%) and severe morbidity (14.1% versus 12.5%) were similar after simultaneous colorectal resection and minor hepatectomy compared with isolated minor hepatectomy (both p > 0.05). For major hepatectomy, simultaneous colorectal resection increased mortality (8.3% versus 1.4%, p < 0.05) and severe morbidity (36.1% versus 15.1%, p < 0.05). Combined severe morbidity after staged resections was lower compared to simultaneous resections (36.1% versus 17.6%, p = 0.05) for major hepatectomy but similar for minor hepatectomy (14.1% versus 10.5%, p > 0.05). Major hepatectomy independently predicted severe morbidity after simultaneous resections [hazard ratio (HR) = 3.4, p = 0.008].

Conclusions

Simultaneous colorectal and minor hepatic resections are safe and should be performed for most patients with SCRLM. Due to increased risk of severe morbidity, caution should be exercised before performing simultaneous colorectal and major hepatic resections.
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Metadata
Title
Simultaneous Resections of Colorectal Cancer and Synchronous Liver Metastases: A Multi-institutional Analysis
Authors
Srinevas K. Reddy, MD
Timothy M. Pawlik, MD, MPH
Daria Zorzi, MD
Ana L. Gleisner, MD
Dario Ribero, MD
Lia Assumpcao, MD
Andrew S. Barbas, BS
Eddie K. Abdalla, MD
Michael A. Choti, MD
Jean-Nicolas Vauthey, MD
Kirk A. Ludwig, MD
Christopher R. Mantyh, MD
Michael A. Morse, MD
Bryan M. Clary, MD
Publication date
01-12-2007
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 12/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-007-9522-5

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