title: Selection criteria for simultaneous resection in patients with synchronous liver metastasis.
abstract: OBJECTIVE
  While simultaneous resection has been shown to be safe and effective in patients with synchronous metastasis, neoadjuvant chemotherapy followed by hepatectomy has gradually gained acceptance for both initially nonresectable metastasis and resectable metastasis. The boundary between these treatments is becoming unclear. We hypothesized that factors associated with colorectal cancer may play an important role in the prognosis of patients with synchronous metastasis and may be useful for identifying patients who can be expected to have adequate results following simultaneous resection.
  
  
  METHODS
  Outcome study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  From January 1980 to December 2002, 187 patients underwent curative resection for synchronous liver metastasis from colorectal cancer. One hundred forty-two patients received simultaneous resection, 18 underwent staged resection, and 27 underwent delayed hepatic resection. Twenty-one clinicopathological factors were analyzed, and long-term prognosis was assessed.
  
  
  METHODS
  Prognostic factors and patient survival.
  
  
  RESULTS
  There was no in-hospital death. In a multivariate analysis, the factors that significantly affected the prognosis of synchronous metastasis were 4 or more lymph node metastases around the primary cancer (P<.001) and multiple liver metastases (P = .003). In patients with 3 or fewer lymph node metastases around the primary cancer, the 5-year survival rates of those with 1, 2 to 3, and 4 or more liver metastases were 63%, 33%, and 40%, respectively, but these rates were 15%, 22%, and 0%, respectively, in patients with 4 or more lymph node metastases around the primary cancer.
  
  
  CONCLUSIONS
  The results support the application of simultaneous resection in patients with 0 to 3 colorectal lymph node metastases. However, in patients with 4 or more colorectal lymph node metastases, biological selection by neoadjuvant chemotherapy may be more suitable.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Minagawa
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Shiro
authors.initials: S
authors.lastname: Miwa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kosuge
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors