Skip to main content

Advertisement

SpringerLink
Log in

Simultaneous Resections of Colorectal Cancer and Synchronous Liver Metastases: A Multi-institutional Analysis

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The safety of simultaneous resections of colorectal cancer and synchronous liver metastases (SCRLM) is not established. This multi-institutional retrospective study compared postoperative outcomes after simultaneous and staged colorectal and hepatic resections.

Methods

Clinicopathologic data, treatments, and postoperative outcomes from patients who underwent simultaneous or staged colorectal and hepatic resections at three hepatobiliary centers from 1985–2006 were reviewed.

Results

610 patients underwent simultaneous (n = 135) or staged (n = 475) resections of colorectal cancer and SCRLM. Seventy staged patients underwent colorectal and hepatic resections at the same institution. Simultaneous patients had fewer (median 1 versus 2) and smaller (median 2.5 versus 3.5 cm) metastases and less often underwent major (≥ three segments) hepatectomy (26.7% versus 61.3%, p < 0.05). Combined hospital stay was lower after simultaneous resections (median 8.5 versus 14 days, p < 0.0001). Mortality (1.0% versus 0.5%) and severe morbidity (14.1% versus 12.5%) were similar after simultaneous colorectal resection and minor hepatectomy compared with isolated minor hepatectomy (both p > 0.05). For major hepatectomy, simultaneous colorectal resection increased mortality (8.3% versus 1.4%, p < 0.05) and severe morbidity (36.1% versus 15.1%, p < 0.05). Combined severe morbidity after staged resections was lower compared to simultaneous resections (36.1% versus 17.6%, p = 0.05) for major hepatectomy but similar for minor hepatectomy (14.1% versus 10.5%, p > 0.05). Major hepatectomy independently predicted severe morbidity after simultaneous resections [hazard ratio (HR) = 3.4, p = 0.008].

Conclusions

Simultaneous colorectal and minor hepatic resections are safe and should be performed for most patients with SCRLM. Due to increased risk of severe morbidity, caution should be exercised before performing simultaneous colorectal and major hepatic resections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abdalla EK, Adam R, Bilchik AJ, et al. Improving respectability of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 2006; 13:1271–80

    Article  PubMed  Google Scholar 

  2. Minagawa M, Yamamoto, Miwa S, et al. Selection criteria for simultaneous resection in patients with synchronous liver metastasis. Arch Surg 2006; 141:1006–12

  3. Benzoni E, Lorenzin D, Baccarani U, et al. Resective surgery for liver tumor: a multivariate analysis of causes and risk factors linked to postoperative complications. Hepatobiliary Pancreat Dis Int 2006; 5:526–33

    PubMed  Google Scholar 

  4. Belghiti J, Hiramatsu K, Benoist S, et al. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 2000; 191:38–46

    Article  PubMed  CAS  Google Scholar 

  5. Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002; 236:397–407

    Article  PubMed  Google Scholar 

  6. Imamura H, Seyama Y, Kokudo N, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 2003; 138:1198–206

    Article  PubMed  Google Scholar 

  7. Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases. Analysis of 1222 consecutive patients from a prospective database. Ann Surg 2004; 240:698–710

    Article  PubMed  Google Scholar 

  8. Dimick JB, Cowan JA, Knol JA, Upchurch GR. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database. Arch Surg 2003; 138:185–91

    Article  PubMed  Google Scholar 

  9. Capussotti L, Ferrero A, Vigano L, et al. Bile leakage and liver resection: where is the risk? Arch Surg 2006; 141:690–4

    Article  PubMed  Google Scholar 

  10. Martin R, Paty P, Fong Y, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastases. J Am Coll Surg 2003; 197:233–42

    Article  PubMed  Google Scholar 

  11. Lyass S, Zamir G, Matot I, et al. Combined colon and hepatic resection for synchronous colorectal liver metastases. J Surg Oncol 2001; 78:17–21

    Article  PubMed  CAS  Google Scholar 

  12. Vogt P, Raab R, Ringe B, Pichlmayr R. Resection of synchronous liver metastases from colorectal cancer. World J Surg 1991; 15:62–7

    Article  PubMed  CAS  Google Scholar 

  13. Weber JC, Bachellier P, Oussoultzoglou E, Jaeck D. Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg 2003; 90:956–62

    Article  PubMed  CAS  Google Scholar 

  14. Doko M, Zovak M, Ledinsky M, et al. Safety of Simultaneous resections of colorectal cancer and liver metastases. Coll Antropol 2000; 24:381–90

    PubMed  CAS  Google Scholar 

  15. Tanaka K, Shimada H, Matsuo K, et al. Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases. Surgery 2004; 136:650–9

    Article  PubMed  Google Scholar 

  16. Vauthey JN, Pawlik TM, Ribero D, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 2006; 24:2065–72

    Article  PubMed  CAS  Google Scholar 

  17. Fernandez FG, Ritter J, Goodwin JW, et al. Effect of steatohepatitis associated with irinotecan or oxaliplatin pretreatment on respectability of hepatic colorectal metastases. J Am Coll Surg 2005; 200:845–53

    Article  PubMed  Google Scholar 

  18. Aloia T, Sebagh M, Plasse M, et al. Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases. J Clin Oncol 2006; 24:4983–90

    Article  PubMed  CAS  Google Scholar 

  19. Karoui M, Penna C, Amin-Hashem M, et al. Influence of chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 2006; 243:1–7

    Article  PubMed  Google Scholar 

  20. Bilchik AJ, Poston G, Curley SA, et al. Neoadjuvant chemotherapy for metastatic colon cancer: a cautionary note. J Clin Oncol 2005; 23:9073–8

    Article  PubMed  CAS  Google Scholar 

  21. Strasberg SM. Terminology of liver anatomy and liver resections: coming to grips with hepatic Babel. J Am Coll Surg 1997; 184:413–34

    PubMed  CAS  Google Scholar 

  22. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205–13

    Article  PubMed  Google Scholar 

  23. Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230:309–18

    Article  PubMed  CAS  Google Scholar 

  24. Kimura F, Miyazaki M, Suwa T, et al. Reduced hepatic acute-phase response after simultaneous resection for gastrointestinal cancer with synchronous liver metastases. Br J Surg 1996; 83:1002–6

    Article  PubMed  CAS  Google Scholar 

  25. Elias D, Detroz B, Lasser P, et al. Is simultaneous hepatectomy and intestinal anastomosis safe? Am J Surg 1995; 169:254–60

    Article  PubMed  CAS  Google Scholar 

  26. Sasanuma H, Yasuda Y, Mortensen FV, et al. Simultaneous colorectal and liver resections for synchronous colorectal metastases. Scand J Surg 2006; 95:176–9

    PubMed  CAS  Google Scholar 

  27. Taniai N, Yoshida H, Mamada Y, et al. Outcome of surgical treatment of synchronous liver metastases from colorectal cancer. J Nippon Med Sch 2006; 73:82–8

    Article  PubMed  Google Scholar 

  28. Capussotti L, Ferrero A, Vigano L, et al. Major liver resections synchronous with colorectal surgery. Ann Surg Oncol 2007; 14:195–201

    Article  PubMed  Google Scholar 

  29. de Santibanes E, Lassalle FB, McCormack L, et al. Simultaneous colorectal and hepatic resections for colorectal cancer: postoperative and longterm outcomes. J Am Coll Surg 2002; 195:196–202

    Article  PubMed  Google Scholar 

  30. Capussotti L, Vigano L, Ferrero A, et al. Timing of resection of liver metastases synchronous to colorectal tumor: proposal for prognosis-based decisional model. Ann Surg Onc 2007; 14(3):1143–1150

    Google Scholar 

  31. Thelen A, Jonas S, Benckert C, et al. Simultaneous versus staged liver resection of synchronous liver metastases from colorectal cancer. Int J Colorectal Dis 2007 Feb 21; [Equb ahead of print]

  32. Bolton JS, Fuhrman GM. Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma. Ann Surg 2000; 231:743–51

    Article  PubMed  CAS  Google Scholar 

  33. Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver: a prognostic scoring system to improve case selection, based on 1568 patients. Cancer 1996; 77:1254–62

    Article  PubMed  CAS  Google Scholar 

  34. Adam R. Colorectal cancer with synchronous liver metastases. Br J Surg 2007; 94:129–31

    Article  PubMed  CAS  Google Scholar 

  35. Chua HK, Sondenaa K, Tsiotos GG, et al. Concurrent vs. staged colectomy and hepatectomy for primary colorectal cancer with synchronous hepatic metastases. Dis Colon Rectum 2004; 47:1310–6

    Article  PubMed  Google Scholar 

  36. Fujita S, Akasu T, Moriya Y. Resection of synchronous liver metastases from colorectal cancer. Jpn J Clin Oncol 2000; 30:7–11

    Article  PubMed  CAS  Google Scholar 

  37. Scheele J, Stangl R, Altendorf-Hofmann A, et al. Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 1991; 110:13–29

    PubMed  CAS  Google Scholar 

  38. Jatzko G, Wette V, Muller M, et al. Simultaneous resection of colorectal carcinoma and synchronous liver metastases in a district hospital. Int J Colorect Dis 1991; 6:111–4

    Article  CAS  Google Scholar 

  39. Sugawara Y, Yamamoto J, Yamasaki S, et al. Estimating the prognosis of hepatic resection in patients with metastatic liver tumors from colorectal cancer with special concern for the timing of hepatectomy. Surgery 2001; 129:408–13

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, Durham, NC, 27710, USA

    Srinevas K. Reddy MD, Andrew S. Barbas BS, Kirk A. Ludwig MD, Christopher R. Mantyh MD & Bryan M. Clary MD

  2. Departments of Medicine, Duke University Medical Center, Durham, NC, 27710, USA

    Michael A. Morse MD

  3. Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA

    Timothy M. Pawlik MD, MPH, Ana L. Gleisner MD, Lia Assumpcao MD & Michael A. Choti MD

  4. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Daria Zorzi MD, Dario Ribero MD, Eddie K. Abdalla MD & Jean-Nicolas Vauthey MD

Authors
  1. Srinevas K. Reddy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timothy M. Pawlik MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daria Zorzi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ana L. Gleisner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dario Ribero MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lia Assumpcao MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrew S. Barbas BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eddie K. Abdalla MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michael A. Choti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jean-Nicolas Vauthey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kirk A. Ludwig MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Christopher R. Mantyh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Michael A. Morse MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Bryan M. Clary MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Srinevas K. Reddy MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reddy, S.K., Pawlik, T.M., Zorzi, D. et al. Simultaneous Resections of Colorectal Cancer and Synchronous Liver Metastases: A Multi-institutional Analysis. Ann Surg Oncol 14, 3481–3491 (2007). https://doi.org/10.1245/s10434-007-9522-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-007-9522-5

Keywords

Search

Navigation