title: Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis.
abstract: BACKGROUND
  The safety of simultaneous resections of colorectal cancer and synchronous liver metastases (SCRLM) is not established. This multi-institutional retrospective study compared postoperative outcomes after simultaneous and staged colorectal and hepatic resections.
  
  
  METHODS
  Clinicopathologic data, treatments, and postoperative outcomes from patients who underwent simultaneous or staged colorectal and hepatic resections at three hepatobiliary centers from 1985-2006 were reviewed.
  
  
  RESULTS
  610 patients underwent simultaneous (n = 135) or staged (n = 475) resections of colorectal cancer and SCRLM. Seventy staged patients underwent colorectal and hepatic resections at the same institution. Simultaneous patients had fewer (median 1 versus 2) and smaller (median 2.5 versus 3.5 cm) metastases and less often underwent major (> or = three segments) hepatectomy (26.7% versus 61.3%, p < 0.05). Combined hospital stay was lower after simultaneous resections (median 8.5 versus 14 days, p < 0.0001). Mortality (1.0% versus 0.5%) and severe morbidity (14.1% versus 12.5%) were similar after simultaneous colorectal resection and minor hepatectomy compared with isolated minor hepatectomy (both p > 0.05). For major hepatectomy, simultaneous colorectal resection increased mortality (8.3% versus 1.4%, p < 0.05) and severe morbidity (36.1% versus 15.1%, p < 0.05). Combined severe morbidity after staged resections was lower compared to simultaneous resections (36.1% versus 17.6%, p = 0.05) for major hepatectomy but similar for minor hepatectomy (14.1% versus 10.5%, p > 0.05). Major hepatectomy independently predicted severe morbidity after simultaneous resections [hazard ratio (HR) = 3.4, p = 0.008].
  
  
  CONCLUSIONS
  Simultaneous colorectal and minor hepatic resections are safe and should be performed for most patients with SCRLM. Due to increased risk of severe morbidity, caution should be exercised before performing simultaneous colorectal and major hepatic resections.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. reddy005@mc.duke.edu
authors.forename: Srinevas K
authors.initials: SK
authors.lastname: Reddy
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Daria
authors.initials: D
authors.lastname: Zorzi
authors.forename: Ana L
authors.initials: AL
authors.lastname: Gleisner
authors.forename: Dario
authors.initials: D
authors.lastname: Ribero
authors.forename: Lia
authors.initials: L
authors.lastname: Assumpcao
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Barbas
authors.forename: Eddie K
authors.initials: EK
authors.lastname: Abdalla
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Ludwig
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mantyh
authors.forename: Michael A
authors.initials: MA
authors.lastname: Morse
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Clary
mesh_terms: D000368:Aged; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate