title: Timing of resection of liver metastases synchronous to colorectal tumor: proposal of prognosis-based decisional model.
abstract: BACKGROUND
  Timing of hepatectomy for synchronous metastases of colorectal cancer is still debated. The aim of this retrospective study was to analyze prognostic factors after synchronous and delayed liver resections to define selection criteria for choosing timing of hepatectomy.
  
  
  METHODS
  The study was performed on 127 patients with synchronous metastases undergoing radical hepatectomy. We divided patients according to the timing of hepatectomy: 70 synchronous (group A) and 57 delayed (group B).
  
  
  RESULTS
  Overall survival was similar between the two groups (5-year survival 30.8% vs. 32.0% A vs. B, P = .406). The multivariate analysis evidenced four independent prognostic factors in group A: male sex (P = .04), T4 (P = .0035), more than three metastases (P = .0001), and metastatic infiltration of nearby structures (P < .0001). There were no statistically significant prognostic factors in group B. Patients with more than three metastases had a significantly worse survival in group A than in group B (3-year survival, 15.0% vs. 34.3%, P = .007); similarly, borderline significant difference was encountered in patients with T4 primary tumor (3-year survival, 16.7% vs. 60%, P = .064)
  
  
  CONCLUSIONS
  Patients with liver metastases synchronous with colorectal cancer with T4 primary tumor, metastasis infiltration of neighboring structures, and especially with more than three metastases should receive neoadjuvant chemotherapy before liver resection.
authors.affiliation: Unit of Surgical Oncology, Institute for Cancer Research and Treatment, Strada Provinciale 142 km 3,95 10060, Candiolo, Torino, Italy. lcapussotti@mauriziano.it
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.forename: Luca
authors.initials: L
authors.lastname: Vigano'
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ferrero
authors.forename: Roberto
authors.initials: R
authors.lastname: Lo Tesoriere
authors.forename: Dario
authors.initials: D
authors.lastname: Ribero
authors.forename: Roberto
authors.initials: R
authors.lastname: Polastri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome