Safety of Simultaneous Bowel and Liver Resections for Colon and Rectal Cancer

The synchronous presentation of primary colorectal cancer and colorectal liver metastasis (CLM) occurs in 23-51 % of all colorectal cancer patients at the time of diagnosis. The optimal treatment of patients with synchronous primary colorectal cancer and CLM has been controversial for decades. Here, the available literature regarding staged versus simultaneous resection of synchronous CLM is reviewed in terms of the perioperative and prognostic outcomes. Recent studies support the safety of a simultaneous approach for the resection of synchronous CLM, demonstrating an equivalent or better short-term outcome compared with a staged approach. The postoperative mortality following either simultaneous or staged resections is reportedly less than 5 %. The long-term prognosis following a simultaneous approach is comparable to that following a staged approach. Most series have demonstrated equivalent overall and disease-free survival periods, regardless of the timing of the resections. An increased perioperative risk following simultaneous major hepatectomies, compared with minor resections, was proposed by several authors. In addition, the operative procedures for multiple liver metastases have changed over time toward a parenchymal-sparing approach, providing better prognostic outcomes than major hepatectomies. The available evidence indicates that comparable short-term as well as long-term outcomes can be expected regardless of a staged or simultaneous resection of synchronous CLM. However, minor resections of colorectal liver metastases can reduce the perioperative risks, providing room for a repeated treatment approach.