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Defining an optimal surgical strategy for synchronous colorectal liver metastases: staged versus simultaneous resection?
Author(s) -
She Wong Hoi,
Chan Albert Chi Yan,
Poon Ronnie Tung Ping,
Cheung Tan To,
Chok Kenneth Siu Ho,
Chan See Ching,
Lo Chung Mau
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12739
Subject(s) - medicine , hepatectomy , resection , overall survival , surgery , colorectal cancer , blood loss , surgical resection , gastroenterology , cancer
Background We aimed to assess if simultaneous resection conferred any survival benefit in resection of synchronous colorectal liver metastases. Methods From J anuary 1990 to D ecember 2008, 116 patients with synchronous colorectal liver metastases were identified. Among these 116 patients, 88 underwent staged resection ( SR ), while the remaining 28 patients underwent simultaneous resection ( SIMR ). Patients’ follow‐up data were reviewed. Results There were no significant differences between the groups in terms of patient and tumour characteristics. Major hepatectomy was performed in 54 patients (61%) undergoing SR , and 12 patients (43%) undergoing SIMR ( P = 0.09). The median blood loss ( SR 0.7 L versus SIMR 0.8 L) was similar. Post‐operative morbidity rates and hospital mortality rates were not statistically different. The total length of hospital stay was shorter in SIMR patients (18.0 versus 11.5 days, P = 0.009). The 1‐, 3‐ and 5‐year overall survival for SR were 90.7%, 47.1% and 33.3%, whilst the corresponding survival rates for SIMR were 75.0%, 25.0% and 0%, respectively ( P = 0.003). However, when the disease‐free survival ( DFS ) was stratified according to the number of hepatic metastases, the survival benefit of SR and SIMR for solitary CRM were similar (3‐year DFS : 28.3% versus 11.1%, P = 0.089). Conclusions Our study showed that an operative strategy of SR generally offered better survival outcome than SIMR in the surgical management of CRM .