title: Surgeon's awareness of the synchronous liver metastases during colorectal cancer resection may affect outcome.
abstract: OBJECTIVE
  There is conflicting evidence about the importance of synchronous metastases upon tumor outcome. The aim of this study is to identify the effect of finding synchronous colorectal liver metastases on the performance of the surgeon whilst operating on primary colorectal cancer.
  
  
  METHODS
  Patients with completed colorectal cancer data who underwent liver resection for colorectal metastases between 1993 and 2001 were included. Two hundred seventy patients were categorised according to the site of the primary tumour (colon or rectum) and knowledge of the presence of liver metastases by the colorectal surgeon (SA=surgeon aware, n=112, SNA=surgeon not aware, n=158). The number of retrieved lymph nodes and colorectal resection margin involvement were used as surgical performance indicators. Survival and local recurrence rate were monitored.
  
  
  RESULTS
  The SA group had a higher rate of colorectal circumferential resection margin involvement, the local and intra-abdominal recurrence rate was also significantly higher in this group (p<0.001).
  
  
  CONCLUSIONS
  Awareness of the presence of liver metastases by the operating surgeon is an independent predictor of intra abdominal extra hepatic recurrence of colorectal cancer following potentially curative hepatic resection. This is related to an increased rate of primary colorectal resection margin involvement.
authors.affiliation: HPB and Transplant Unit, St. James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: Z Z R
authors.initials: ZZ
authors.lastname: Hamady
authors.forename: H Z
authors.initials: HZ
authors.lastname: Malik
authors.forename: N
authors.initials: N
authors.lastname: Alwan
authors.forename: J I
authors.initials: JI
authors.lastname: Wyatt
authors.forename: K R
authors.initials: KR
authors.lastname: Prasad
authors.forename: R K
authors.initials: RK
authors.lastname: Prasad
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: G T
authors.initials: GT
authors.lastname: Toogood
authors.forename: J P A
authors.initials: JP
authors.lastname: Lodge
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D011336:Probability; D016016:Proportional Hazards Models; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis