title: Efficacy of the predicted operation time (POT) strategy for synchronous colorectal liver metastasis (SCLM): feasibility study for staged resection in patients with a long POT.
abstract: BACKGROUND
  The optimal surgical strategy for resectable synchronous colorectal liver metastases (SCLM), whether simultaneous or staged resections, still remains obscure. The aim of this study was to assess the efficacy of the predicted operation time (POT) strategy, which recommends staged resections in case of POT ≥6 h, otherwise selecting simultaneous resection.
  
  
  METHODS
  This was a prospective, nonrandomized, single-institution study. Fifty-nine patients with SCLM underwent tumor resection according to the POT strategy, with patients with a longer POT (≥6 h) undergoing staged resection. Morbidity, overall hospitalization, tumor resection rates, and survival were compared with that of 86 patients who underwent simultaneous resection for SCLM irrespective of POT from 1992 to 2004.
  
  
  RESULTS
  The former simultaneous and the latter POT strategy groups were similar in terms of patient and tumor demographics as well as surgical procedures. Of the 59 POT group patients, 26 patients (44 %) experienced 40 postoperative complications. Comparing the surgical results of simultaneous resection from 1992 to 2004 and those of resection according to the POT strategy, morbidity (64 vs. 44 %, p = 0.02), frequency of anastomotic leakage (21 vs. 5 %, p < 0.01), and length of hospital stay (27 vs. 18 days, p < 0.01) were significantly lower in the latter group, while tumor resection rates (85 vs. 87 %, p = 0.77) were not different.
  
  
  CONCLUSIONS
  The POT strategy is effective in reducing the morbidity in SCLM patients by selecting staged resections in the high-morbidity-risk group without adverse effects on oncologic outcome.
authors: Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors: Kentaro
authors: K
authors: Nakajima
authors: Shinichiro
authors: S
authors: Takahashi
authors: Norio
authors: N
authors: Saito
authors: Masanori
authors: M
authors: Sugito
authors: Masaru
authors: M
authors: Konishi
authors: Takahiro
authors: T
authors: Kinoshita
authors: Naoto
authors: N
authors: Gotohda
authors: Yuichiro
authors: Y
authors: Kato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies
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