title: 'Staged' liver resection in synchronous and metachronous colorectal hepatic metastases: differences in clinicopathological features and outcome.
abstract: OBJECTIVE
  Approximately 25% of the patients with colorectal cancer already have liver metastases at diagnosis and another 30% will develop them subsequently. The features and prognosis of patients with synchronous and metachronus colorectal liver metastases, treated with primary resection first followed by partial liver resection were analysed.
  
  
  METHODS
  Curative staged resection of liver metastases was performed in 272 consecutive patients. Demographics, characteristics of the primary tumour and metastatic tumours, surgery-related data and outcome were analysed.
  
  
  RESULTS
  Synchronous metastases were present in 105 (39%) patients and metachronous metastases in 167 (61%). More patients in the synchronous group had an advanced primary tumour (T3/T4 and/or node positivity), more than three liver metastases and bilobar distribution. A significantly higher percentage of patients in the synchronous group received neoadjuvant chemotherapy. The 5-year survival rate in the group of 272 patients was 38%. Patients with more than three metastases had a significantly worse survival rate. There were no differences in disease-free and overall survival rates between the synchronous and metachronous group.
  
  
  CONCLUSIONS
  Although patients with synchronous colorectal liver metastases may have poorer biological features, there was no difference in 5-year disease-free and overall survival compared with patients with metachronous metastases. This may be explained by the observation that patients in the synchronous group received significantly more neoadjuvant chemotherapy.
authors.affiliation: Division of Surgical Oncology, Erasmus University MC, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
authors.forename: A E M
authors.initials: AE
authors.lastname: van der Pool
authors.forename: Z S
authors.initials: ZS
authors.lastname: Lalmahomed
authors.forename: Y
authors.initials: Y
authors.lastname: Ozbay
authors.forename: J H W
authors.initials: JH
authors.lastname: de Wilt
authors.forename: A M M
authors.initials: AM
authors.lastname: Eggermont
authors.forename: J N M
authors.initials: JN
authors.lastname: Jzermans
authors.forename: C
authors.initials: C
authors.lastname: Verhoef
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D013997:Time Factors; D016896:Treatment Outcome