Surgical approaches of resectable synchronous colorectal liver metastases: timing considerations.
OBJECTIVE
To compare the safety and efficacy of simultaneous versus two stage resection of primary colorectal tumors and liver metastases.


METHODS
From January 1996 to May 2004, 103 colorectal tumor patients presented with synchronous liver metastases. Twenty five underwent simultaneous colorectal and liver surgery and 78 underwent liver surgery 1-3 mo after primary colorectal tumor resection. Data were retrospectively analyzed to assess and compare the morbidity and mortality between the surgical strategies. The two groups were comparable regarding the age and sex distribution, the types of liver resection and stage of primary tumors, as well as the number and size of liver metastases.


RESULTS
In two-stage procedures more transfusions were required (4 +/- 1.5 vs 2 +/- 1.8, pRBCs, P < 0.05). Chest infection was increased after the two-stage approach (26% vs 17%, P < 0.05). The two-stage procedure was also associated with longer hospitalization (20 +/- 8 vs 12 +/- 6 d, P < 0.05). Five year survival in both groups was similar (28% vs 31%). No hospital mortality occurred in our series.


CONCLUSIONS
Synchronous colorectal liver metastases can be safely treated simultaneously with the primary tumor. Liver resection should be prioritized over colon resection. It is advisable that complex liver resections with marginal liver residual volume should be dealt with at a later stage.
Vassiliou
Ioannis
I
2nd Department of Surgery, Aretaieion Hospital, University of Athens, School of Medicine, FACS, 29 El. Venizelou str., GR-154 51 Athens, Greece. ianvass@otenet.gr
Arkadopoulos
Nick
N
Theodosopoulos
Theodosios
T
Fragulidis
Georgios
G
Marinis
Athanasios
A
Kondi-Paphiti
Agathi
A
Samanides
Lazaros
L
Polydorou
Andreas
A
Gennatas
Constantinos
C
Voros
Dionysios
D
Smyrniotis
Vassilios
V
D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors