Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: European Surgery 4/2016

01.08.2016 | Original Article

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

verfasst von: J. Schuld, M. von Heesen, B. Jung, S. Richter, MD O. Kollmar

Erschienen in: European Surgery | Ausgabe 4/2016

Einloggen, um Zugang zu erhalten
share
TEILEN

Summary

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.
Literatur
1.
Zurück zum Zitat Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64:104–17. CrossRefPubMed Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64:104–17. CrossRefPubMed
2.
Zurück zum Zitat Kusters M, Valentini V, Calvo FA, Krempien R, Nieuwenhuijzen GA, et al. Results of European pooled analysis of IORT-containing multimodality treatment for locally advanced rectal cancer: adjuvant chemotherapy prevents local recurrence rather than distant metastases. Ann Oncol. 2010;21:1279–84. CrossRefPubMed Kusters M, Valentini V, Calvo FA, Krempien R, Nieuwenhuijzen GA, et al. Results of European pooled analysis of IORT-containing multimodality treatment for locally advanced rectal cancer: adjuvant chemotherapy prevents local recurrence rather than distant metastases. Ann Oncol. 2010;21:1279–84. CrossRefPubMed
3.
Zurück zum Zitat Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, et al. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol. 2007;14:3481–91. CrossRefPubMed Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, et al. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol. 2007;14:3481–91. CrossRefPubMed
4.
Zurück zum Zitat Martin RC II, Augenstein V, Reuter NP, Scoggins CR, McMasters KM. Simultaneous versus staged resection for synchronous colorectal cancer liver metastases. J Am Coll Surg. 2009;208:842–50. (discussion 850–842). CrossRefPubMed Martin RC II, Augenstein V, Reuter NP, Scoggins CR, McMasters KM. Simultaneous versus staged resection for synchronous colorectal cancer liver metastases. J Am Coll Surg. 2009;208:842–50. (discussion 850–842). CrossRefPubMed
5.
Zurück zum Zitat Bengtsson G, Carlsson G, Hafstrom L, Jonsson PE. Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg. 1981;141:586–9. CrossRefPubMed Bengtsson G, Carlsson G, Hafstrom L, Jonsson PE. Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg. 1981;141:586–9. CrossRefPubMed
6.
Zurück zum Zitat von Heesen M, Schuld J, Sperling J, Grunhage F, Lammert F, et al. Parenchyma-preserving hepatic resection for colorectal liver metastases. Langenbecks Arch Surg. 2012;397:383–95. CrossRef von Heesen M, Schuld J, Sperling J, Grunhage F, Lammert F, et al. Parenchyma-preserving hepatic resection for colorectal liver metastases. Langenbecks Arch Surg. 2012;397:383–95. CrossRef
7.
Zurück zum Zitat Mansour J, Fong Y. Timing of the liver resection for patients with synchronous metastases: practical and outcome considerations. Ann Surg Oncol. 2007;14:2435–6. CrossRefPubMed Mansour J, Fong Y. Timing of the liver resection for patients with synchronous metastases: practical and outcome considerations. Ann Surg Oncol. 2007;14:2435–6. CrossRefPubMed
8.
Zurück zum Zitat Hopt UT, Drognitz O, Neeff H. Timing of resection in patients with colorectal carcinoma and synchronous liver metastases. Zentralbl Chir. 2009;134:425–9. CrossRefPubMed Hopt UT, Drognitz O, Neeff H. Timing of resection in patients with colorectal carcinoma and synchronous liver metastases. Zentralbl Chir. 2009;134:425–9. CrossRefPubMed
9.
Zurück zum Zitat Yin Z, Liu C, Chen Y, Bai Y, Shang C, et al. Timing of hepatectomy in resectable synchronous colorectal liver metastases (SCRLM): simultaneous or delayed? Hepatology. 2013;57:2346–57. CrossRefPubMed Yin Z, Liu C, Chen Y, Bai Y, Shang C, et al. Timing of hepatectomy in resectable synchronous colorectal liver metastases (SCRLM): simultaneous or delayed? Hepatology. 2013;57:2346–57. CrossRefPubMed
10.
Zurück zum Zitat Martin R, Paty P, Fong Y, Grace A, Cohen A, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg. 2003;197:233–41. (discussion 241–232). CrossRefPubMed Martin R, Paty P, Fong Y, Grace A, Cohen A, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg. 2003;197:233–41. (discussion 241–232). CrossRefPubMed
11.
Zurück zum Zitat Reddy SK, Barbas AS, Clary BM. Synchronous colorectal liver metastases: is it time to reconsider traditional paradigms of management? Ann Surg Oncol. 2009;16:2395–410. CrossRefPubMed Reddy SK, Barbas AS, Clary BM. Synchronous colorectal liver metastases: is it time to reconsider traditional paradigms of management? Ann Surg Oncol. 2009;16:2395–410. CrossRefPubMed
12.
Zurück zum Zitat Chen J, Li Q, Wang C, Zhu H, Shi Y, et al. Simultaneous vs. staged resection for synchronous colorectal liver metastases: a metaanalysis. Int J Colorectal Dis. 2011;26:191–9. CrossRefPubMed Chen J, Li Q, Wang C, Zhu H, Shi Y, et al. Simultaneous vs. staged resection for synchronous colorectal liver metastases: a metaanalysis. Int J Colorectal Dis. 2011;26:191–9. CrossRefPubMed
13.
Zurück zum Zitat Capussotti L, Ferrero A, Vigano L, Ribero D, Lo Tesoriere R, et al. Major liver resections synchronous with colorectal surgery. Ann Surg Oncol. 2007;14:195–201. CrossRefPubMed Capussotti L, Ferrero A, Vigano L, Ribero D, Lo Tesoriere R, et al. Major liver resections synchronous with colorectal surgery. Ann Surg Oncol. 2007;14:195–201. CrossRefPubMed
14.
Zurück zum Zitat Minagawa M, Yamamoto J, Miwa S, Sakamoto Y, Kokudo N, et al. Selection criteria for simultaneous resection in patients with synchronous liver metastasis. Arch Surg. 2006;141:1006–12. (discussion 1013). CrossRefPubMed Minagawa M, Yamamoto J, Miwa S, Sakamoto Y, Kokudo N, et al. Selection criteria for simultaneous resection in patients with synchronous liver metastasis. Arch Surg. 2006;141:1006–12. (discussion 1013). CrossRefPubMed
15.
Zurück zum Zitat 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. CrossRefPubMed 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. CrossRefPubMed
16.
Zurück zum Zitat Tanaka K, Shimada H, Matsuo K, Nagano Y, Endo I, et al. Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases. Surgery. 2004;136:650–9. CrossRefPubMed Tanaka K, Shimada H, Matsuo K, Nagano Y, Endo I, et al. Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases. Surgery. 2004;136:650–9. CrossRefPubMed
17.
Zurück zum Zitat Thelen A, Jonas S, Benckert C, Spinelli A, Lopez-Hanninen E, et al. Simultaneous versus staged liver resection of synchronous liver metastases from colorectal cancer. Int J Colorectal Dis. 2007;22:1269–76. CrossRefPubMed Thelen A, Jonas S, Benckert C, Spinelli A, Lopez-Hanninen E, et al. Simultaneous versus staged liver resection of synchronous liver metastases from colorectal cancer. Int J Colorectal Dis. 2007;22:1269–76. CrossRefPubMed
18.
Zurück zum Zitat Hillingso JG, Wille-Jorgensen P. Staged or simultaneous resection of synchronous liver metastases from colorectal cancer—a systematic review. Colorectal Dis. 2009;11:3–10. CrossRefPubMed Hillingso JG, Wille-Jorgensen P. Staged or simultaneous resection of synchronous liver metastases from colorectal cancer—a systematic review. Colorectal Dis. 2009;11:3–10. CrossRefPubMed
19.
Zurück zum Zitat Pathak S, Sarno G, Nunes QM, Poston GJ. Synchronous resection for colorectal liver metastases: the future. Eur J Surg Oncol. 2010;36:1044–6. CrossRefPubMed Pathak S, Sarno G, Nunes QM, Poston GJ. Synchronous resection for colorectal liver metastases: the future. Eur J Surg Oncol. 2010;36:1044–6. CrossRefPubMed
20.
Zurück zum Zitat Mentha G, Majno P, Terraz S, Rubbia-Brandt L, Gervaz P, et al. Treatment strategies for the management of advanced colorectal liver metastases detected synchronously with the primary tumour. Eur J Surg Oncol. 2007;33(Suppl 2):S76–83. CrossRefPubMed Mentha G, Majno P, Terraz S, Rubbia-Brandt L, Gervaz P, et al. Treatment strategies for the management of advanced colorectal liver metastases detected synchronously with the primary tumour. Eur J Surg Oncol. 2007;33(Suppl 2):S76–83. CrossRefPubMed
21.
Zurück zum Zitat Abbott AM, Parsons HM, Tuttle TM, Jensen EH. Short-term outcomes after combined colon and liver resection for synchronous colon cancer liver metastases: a population study. Ann Surg Oncol. 2013;20:139–47. CrossRefPubMed Abbott AM, Parsons HM, Tuttle TM, Jensen EH. Short-term outcomes after combined colon and liver resection for synchronous colon cancer liver metastases: a population study. Ann Surg Oncol. 2013;20:139–47. CrossRefPubMed
22.
Zurück zum Zitat Luo Y, Wang L, Chen C, Chen D, Huang M, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastases. J Gastrointest Surg. 2010;14:1974–80. CrossRefPubMed Luo Y, Wang L, Chen C, Chen D, Huang M, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastases. J Gastrointest Surg. 2010;14:1974–80. CrossRefPubMed
23.
Zurück zum Zitat Kaibori M, Iwamoto S, Ishizaki M, Matsui K, Saito T, et al. Timing of resection for synchronous liver metastases from colorectal cancer. Dig Dis Sci. 2010;55:3262–70. CrossRefPubMed Kaibori M, Iwamoto S, Ishizaki M, Matsui K, Saito T, et al. Timing of resection for synchronous liver metastases from colorectal cancer. Dig Dis Sci. 2010;55:3262–70. CrossRefPubMed
Metadaten
Titel
Simultaneous resection of primary colorectal cancer and synchronous liver metastases is associated with a high cardiovascular complication rate
verfasst von
J. Schuld
M. von Heesen
B. Jung
S. Richter
MD O. Kollmar
Publikationsdatum
01.08.2016
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 4/2016
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-015-0382-0