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Published in:

01-01-2007

Major Liver Resections Synchronous with Colorectal Surgery

Authors: Lorenzo Capussotti, MD, Alessandro Ferrero, MD, Luca Viganò, MD, Dario Ribero, MD, Roberto Lo Tesoriere, MD, Roberto Polastri, MD

Published in: Annals of Surgical Oncology | Issue 1/2007

Abstract

Background

Surgical strategy in liver metastases synchronous to colorectal cancer remains controversial. The aim of this study was to evaluate feasibility and short-term outcomes of major hepatectomies synchronous to colorectal surgery.

Methods

Between January 1985 and December 2004, 79 patients underwent major hepatectomy for metastases synchronous to colorectal cancer; 31 underwent synchronous hepatectomy and colorectal surgery, and 48 underwent delayed liver resection.

Results

The synchronous group had a higher rate of right colectomy (38.7% vs. 18.8%, P = .0499) and larger metastases (8 vs. 5.3 cm, P = .0032). Mortality (one patient in synchronous group), morbidity, and anastomotic leak rates were similar in the two groups. Colon-related morbidity did not cause adjunctive liver complications. Hospitalization in delayed hepatectomies was shorter (10.4 days vs. 13.9 days, P = .0021). Blood and plasma transfusions were higher in synchronous resections (41.9% vs. 16.7%, P = .0131 and 54.8% vs. 31.3%, P = .0370); no differences were found in the last 10 years. Considering both surgical procedures (colorectal + liver resection), in delayed hepatectomies, morbidity was higher (56.3% vs. 32.6%, P = .0369) and hospitalization was longer (20.5 vs. 13.9 days, P = .00001). Nine patients underwent major hepatectomy at the same time as anterior rectal resection with no mortality (morbidity 22.2%, mean hospitalization 12.4 days).

Conclusions

Major hepatectomies can be safely performed at the same time as colorectal surgery in selected patients with synchronous metastases with similar short-term results, even in the presence of rectal cancer.

Adam R, Pascal G, Azoulay D, Tanaka K, Castaing D, Bismuth H. Liver resection for colorectal metastases: the third hepatectomy. Ann Surg 2003; 238:871–83; discussion 883–4PubMedCrossRef

D’Angelica M, Brennan MF, Fortner JG, Cohen AM, Blumgart LH, Fong Y. Ninety-six five-year survivors after liver resection for metastatic colorectal cancer. J Am Coll Surg 1997; 185:554–9PubMedCrossRef

Ferrero A, Polastri R, Muratore A, Zorzi D, Capussotti L. Extensive resections for colorectal liver metastases. J Hepatobiliary Pancreat Surg 2004; 11:92–6PubMedCrossRef

Bolton JS, Fuhrman GM. Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma. Ann Surg 2000; 231:743–51PubMedCrossRef

Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver: a prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer 1996; 77:1254–62PubMedCrossRef

Belghiti J. Synchronous and resectable hepatic metastases of colorectal cancer: should there be a minimum delay before hepatic resection? Ann Chir 1990; 44:427–9; discussion 429–32PubMed

Elias D, Detroz B, Lasser P, Plaud B, Jerbi G. Is simultaneous hepatectomy and intestinal anastomosis safe? Am J Surg 1995; 169:254–60PubMedCrossRef

de Santibanes E, Lassalle FB, McCormack L, et al. Simultaneous colorectal and hepatic resections for colorectal cancer: postoperative and longterm outcomes. J Am Coll Surg 2002; 195:196–202PubMedCrossRef

Martin R, Paty P, Fong Y, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 2003; 197:233–41; discussion 241–2PubMedCrossRef

10.

Lyass S, Zamir G, Matot I, Goitein D, Eid A, Jurim O. Combined colon and hepatic resection for synchronous colorectal liver metastases. J Surg Oncol 2001; 78:17–21PubMedCrossRef

11.

Chua HK, Sondenaa K, Tsiotos GG, Larson DR, Wolff BG, Nagorney DM. Concurrent vs staged colectomy and hepatectomy for primary colorectal cancer with synchronous hepatic metastases. Dis Colon Rectum 2004; 47:1310–6PubMedCrossRef

12.

Tanaka K, Shimada H, Matsuo K, et al. Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases. Surgery 2004; 136:650–9PubMedCrossRef

13.

Jaeck D, Bachellier P, Weber JC, et al. Surgical strategy in the treatment of synchronous hepatic metastases of colorectal cancers: analysis of a series of 59 operated on patients. Chirurgie 1999; 124:258–63PubMedCrossRef

14.

Weber JC, Bachellier P, Oussoultzoglou E, Jaeck D. Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg 2003; 90:956–62PubMedCrossRef

15.

Vogt P, Raab R, Ringe B, Pichlmayr R. Resection of synchronous liver metastases from colorectal cancer. World J Surg 1991; 15:62–7PubMedCrossRef

16.

Schlag P, Hohenberger P, Herfarth C. Resection of liver metastases in colorectal cancer: competitive analysis of treatment results in synchronous versus metachronous metastases. Eur J Surg Oncol 1990; 16:360–5PubMed

17.

Terminology Committee of the International Hepato-Pancreato-Biliary Association. Brisbane 2000 terminology of liver anatomy and resection. HPB 2000; 2:333–9

18.

International Union Against Cancer (UICC). TNM: Classification of Malignant Tumours. 6th ed. New York: Wiley-Liss, 2002

19.

Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Registry of Hepatic Metastases. Surgery 1988; 103:278–88

20.

Michelassi F, Block GE, Vannucci L, Montag A, Chappell R. A 5- to 21-year follow-up and analysis of 250 patients with rectal adenocarcinoma. Ann Surg 1988; 208:379–89PubMedCrossRef

21.

Pescatori M, Mattana C, Maria G, Ferrara A, Lucibello L. Outcome of colorectal cancer. Br J Surg 1987; 74:370–2PubMedCrossRef

22.

Scheele J, Stangl R, Altendorf-Hofmann A, Gall FP. Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 1991; 110:13–29PubMed

23.

Minagawa M, Makuuchi M, Torzilli G, et al. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg 2000; 231:487–99PubMedCrossRef

24.

Allen PJ, Kemeny N, Jarnagin W, DeMatteo R, Blumgart L, Fong Y. Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases. J Gastrointest Surg 2003; 7:109–15; discussion 116–7PubMedCrossRef

25.

Fujita S, Akasu T, Moriya Y. Resection of synchronous liver metastases from colorectal cancer. Jpn J Clin Oncol 2000; 30:7–11PubMedCrossRef

26.

Sugawara Y, Yamamoto J, Yamasaki S, Shimada K, Kosuge T, Makuuchi M. Estimating the prognosis of hepatic resection in patients with metastatic liver tumors from colorectal cancer with special concern for the timing of hepatectomy. Surgery 2001; 129:408–13PubMed

27.

Tanaka K, Adam R, Shimada H, Azoulay D, Levi F, Bismuth H. Role of neoadjuvant chemotherapy in the treatment of multiple colorectal metastases to the liver. Br J Surg 2003; 90:963–9PubMedCrossRef

28.

Shinagawa N, Hisada M, Ishihara H, et al. Postoperative infection control in patients with hepatic, biliary tract, and pancreatic cancers. Gan To Kagaku Ryoho 1992; 19:173–7PubMed

29.

Miyazaki M, Kohda S, Itoh H, et al. Inhibition of hepatic regeneration after 70% partial hepatectomy by simultaneous resection of the bowel in rats. Eur Surg Res 1995; 27:396–405PubMed

30.

Kimura F, Miyazaki M, Suwa T, et al. Reduced hepatic acute-phase response after simultaneous resection for gastrointestinal cancer with synchronous liver metastases. Br J Surg 1996; 83:1002–6PubMedCrossRef

31.

Figueras J, Llado L, Ruiz D, et al. Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial. Ann Surg 2005; 241:582–90PubMedCrossRef

32.

Poon RT, Chu KW, Ho JW, Chan CW, Law WL, Wong J. Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision. World J Surg 1999; 23:463–7; discussion 467–8PubMedCrossRef

33.

Peeters KC, Tollenaar RA, Marijnen CA, et al. Dutch Colorectal Cancer Group. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 2005; 92:211–6PubMedCrossRef

Title: Major Liver Resections Synchronous with Colorectal Surgery
Authors: Lorenzo Capussotti, MD
Alessandro Ferrero, MD
Luca Viganò, MD
Dario Ribero, MD
Roberto Lo Tesoriere, MD
Roberto Polastri, MD
Publication date: 01-01-2007
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 1/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-006-9055-3

At a glance: The STEP trials

Springer Medicine

Major Liver Resections Synchronous with Colorectal Surgery

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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