title: Surgical approaches of resectable synchronous colorectal liver metastases: timing considerations.
abstract: 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.
authors: 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
authors: Ioannis
authors: I
authors: Vassiliou
authors: Nick
authors: N
authors: Arkadopoulos
authors: Theodosios
authors: T
authors: Theodosopoulos
authors: Georgios
authors: G
authors: Fragulidis
authors: Athanasios
authors: A
authors: Marinis
authors: Agathi
authors: A
authors: Kondi-Paphiti
authors: Lazaros
authors: L
authors: Samanides
authors: Andreas
authors: A
authors: Polydorou
authors: Constantinos
authors: C
authors: Gennatas
authors: Dionysios
authors: D
authors: Voros
authors: Vassilios
authors: V
authors: Smyrniotis
mesh_terms: 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