Elsevier

Surgery

Volume 155, Issue 3, March 2014, Pages 478-485
Surgery

Original Communication
Evaluation of the safety and efficacy of simultaneous resection of primary colorectal cancer and synchronous colorectal liver metastases

https://doi.org/10.1016/j.surg.2013.10.015Get rights and content

Background

It remains unclear whether primary colorectal cancer and synchronous liver metastases (SLMs) should be resected simultaneously or with a staged procedure.

Methods

We reviewed the short-term outcomes of 127 patients who underwent simultaneous resection of primary colorectal cancer and SLM at our institution from January 1993 to December 2011.

Results

The proportion of simultaneous resections was 84.7% (127 of 150 patients). There was no postoperative mortality, and the postoperative complication rate was 61.4%. Major complications occurred in 23 (18.2%) patients, and anastomotic failure occurred in 2 (1.6%). The 3-, 5-, and 10-year overall survival rates were 74%, 64%, and 52%, respectively. The median recurrence-free survival period was 7.0 months (95% confidence interval, 4.5–9.5 months) and the 5-year recurrence-free survival rate was 17%.

Conclusion

Simultaneous resection can be performed safely in patients with colorectal cancer and SLM.

Section snippets

Patients

With prospectively collected data from the Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, University of Tokyo (Tokyo, Japan), we identified a total of 425 patients who underwent initial hepatectomy for colorectal liver metastases from January 1993 to December 2011. Of these 425 patients, we reviewed 150 consecutive patients who underwent macroscopically curative resection for primary colorectal cancer and SLM. SLM was defined as liver tumor detected before or during primary

Results

The intraoperative and postoperative outcomes are summarized in Table II.19, 20 The median operative duration was 553 minutes (range, 235–1,085 minutes) and the median intraoperative blood loss was 815 mL (range, 81–3,770 mL). There was no postoperative mortality. The incidence of postoperative complications (≥grade 1; Clavien–Dindo classification) was 61%. Major complications (≥grade 3) occurred in 23 (18%) patients.

There was 1 patient with grade A postoperative liver dysfunction according to

Discussion

The present study showed favorable outcomes and a high rate of simultaneous resection of 85% (127/150 patients), which was the greatest among the rates reported in recently published studies (range, 28%–55%; Table IV).6, 7, 8, 9, 10, 11, 12, 13, 22 The rate of major hepatectomy was also low at 14.2%, a characteristic finding of our study. Despite the high rate of simultaneous resection, there was no postoperative mortality, and the morbidity of 61% in the present study was comparable with that

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