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Gastroenterologie 26. September 2016

Simultaneous resection of primary colorectal cancer and synchronous liver metastases is associated with a high cardiovascular complication rate

Background: Optimal timing of liver surgery for synchronous metastases regarding a simultaneous or two-staged procedure is still controversially discussed. As randomized controlled trials are ethically disputable due to potential advantages of the simultaneous approach, the following matched pair analysis was performed to investigate feasibility and short-term outcome of the additional simultaneous hepatic approach compared to colorectal surgery alone.

Methods: A total of 74 patients undergoing simultaneous resection of primary colorectal cancer and synchronous liver metastases (CRC + LM) were individually case matched with patients receiving only colorectal surgery for Union for International Cancer Control (UICC) stage I-III cancer (CRC) according to: age, gender, American Society of Anesthesiologists (ASA) score, location, and T-stage of the primary tumor. Postoperative complications and risk factors for morbidity and mortality were analyzed retrospectively using univariate, multivariate, and binary logistic regression analyses.

Results: According to matching criteria both groups showed no differences regarding demographics and operative techniques for the primary colorectal tumor. In the CRC + LM group 4 major hepatectomies, 7 anatomic, 43 nonanatomic and 20 multiple nonanatomic resections were performed. Inhospital mortality (CRC vs. CRC + LM) was 2.7 versus 4.1 % and overall morbidity was 33.8 versus 35.1 %, respectively. Cardiovascular complications were significantly higher in the CRC + LM than in the CRC group (13.5 vs. 2.7 %). Multivariate analysis revealed that not simultaneous resection procedure but presence of chronic pulmonary disease was an independent risk factor.

Conclusions: Simultaneous resection procedures can be recommended in almost all patients without chronic pulmonary disease as well as chronic heart disease. Careful precautions, especially in patients with chronic pulmonary diseases, should be taken to avoid a high possibility of postoperative cardiovascular complications.

J. Schuld, M. Heesen, B. Jung, S. Richter, O. Kollmar, European Surgery 4/2016

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