Elsevier

Surgery

Volume 136, Issue 3, September 2004, Pages 650-659
Surgery

Original Communication
Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases

https://doi.org/10.1016/j.surg.2004.02.012Get rights and content

Abstract

Background

Consensus has not been reached concerning the timing of hepatectomy in patients with synchronous colorectal liver metastases, specifically with respect to patient selection criteria for simultaneous resection of the colorectal primary and the liver metastasis.

Methods

Retrospectively obtained clinicopathologic data for 39 consecutive patients with synchronous colorectal cancer metastases to the liver, who underwent curative simultaneous “1-stage” hepatectomy and resection of the colorectal primary at 1 institution, were subjected to univariate and multivariate analysis concerning the safety and success of the combined procedure.

Results

Only the volume of the resected liver was selected as a risk factor for postoperative complications (350 g mean resected liver volume in patients with postoperative complications vs 150 g in those without complications; P < .05). Patient age of 70 years or older (P < .05) and poorly differentiated or mucinous adenocarcinoma as the primary lesion (P < .01) predicted decreased overall survival by univariate analysis. Multivariate analysis retained histologic differentiation of the colorectal primary as an independent survival predictor (P < .05).

Conclusions

A 1-stage procedure appears desirable for synchronous colorectal hepatic metastases except for patients requiring resection of more than 1 hepatic section, patients aged 70 years or older, and those with poorly differentiated or mucinous adenocarcinomas as primary lesions.

Section snippets

Patients and methods

From 1992 to 2003, 319 patients in whom liver metastases from colorectal cancer were diagnosed were referred to the Department of Gastroenterological Surgery at Yokohama City University Graduate School of Medical Science. Of these patients, 190 underwent liver resection with curative intent. Hepatic metastases synchronous with colorectal primaries were diagnosed in 91 patients (48%); among these patients, 41 underwent simultaneous colorectal and hepatic resection. Data from 39 consecutive

Results

Subjects undergoing simultaneous resection of the colorectal primary and the liver metastases included 20 men and 19 women with a median age of 64 years (range, 32 to 83). Sites of the primary neoplasm were colon (n = 24) and rectum (n = 15), with 36 of 39 neoplasms classified as T3/T4 and 26 of 39 as N+, according to the TNM classification. Operations for primary colorectal cancer involved low anterior resection in 15 patients, right hemicolectomy in 9, sigmoidectomy in 4, transverse colectomy in

Discussion

A colorectal primary cancer and a synchronous liver metastasis can be resected in 1 procedure under selected circumstances in which both safety and effectiveness of resection are enhanced by this choice. Several risks must be considered in the 1-stage procedure. First, intraoperative bacterial contamination of the cut liver surface may be more likely because of the intestinal resection. Second, postoperative anastomotic leakage may be favored by impairment of liver function, reflecting the

Conclusion

We concluded that patients who required resection of more than 1 hepatic section to remove liver metastases, patients 70 years of age or older, and patients with poorly differentiated or mucinous adenocarcinoma as the primary lesion should not undergo simultaneous colorectal and hepatic resections. These selection criteria, which require no special equipment to apply, should be useful in surgical decision making. Further investigation of a greater number of patients is needed to verify these

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