Evidence for a synchronous operative approach in the treatment of colorectal cancer with hepatic metastases: a case matched study.
BACKGROUND
Traditionally, a staged operative approach has been used for patients with synchronous colorectal cancer and liver metastases in the U.K. With improved outcomes from hepatic resection the role of a synchronous operative approach needs re-evaluated.


METHODS
32 consecutive patients with colorectal cancer and hepatic metastases that underwent a synchronous operative approach were individually case matched (according to: age; sex; ASA grade; type of hepatic and colonic resection) with patients that had undergone a staged approach. The following variables were analysed: operative blood loss; in hospital morbidity and mortality; duration of hospital stay; disease free and overall survival.


RESULTS
Operative blood losses were: synchronous group, median 475mL (range 150-850mL) vs median 425mL (range 50-1700mL), (p>0.050). There were no significant differences in morbidity: (34% synchronous group vs 59%, p=0.690) with no recorded mortality. Synchronous group had a shorter hospital stay (median 12 days [range 8-21] vs 20 [range 7-51], p=0.008). There were no statistical differences between synchronous and staged patients for disease free and overall survival: 10 months (95% CI 5.8-13.7) versus 14 (95% CI 12.2-16.3; p=0.487) and 21% versus 24% at 5 years (p=0.838).


CONCLUSIONS
This present study provides supporting evidence for synchronous operative procedures in patients with colorectal liver metastases.
Moug
S J
SJ
Academic Department of Surgery, Queen Elizabeth Building, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, United Kingdom. susanmoug@nhs.net
Smith
D
D
Leen
E
E
Roxburgh
C
C
Horgan
P G
PG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome