Original CommunicationOutcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases
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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2019, Journal of Surgical ResearchCitation Excerpt :Although many attempts have been made to identify a subset of patients who can tolerate the synchronous resection without increased morbidity or mortality, these series often lack the power or are affected by referral center bias. There have been many reports of excellent outcomes in highly specialized centers.9,11,14,21 However, it is unclear whether similar results are being achieved outside of these centers.
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