title: Surgical management of patients with synchronous colorectal liver metastasis: a multicenter international analysis.
abstract: BACKGROUND
  The goal of this study was to investigate the surgical management and outcomes of patients with primary colorectal cancer (CRC) and synchronous liver metastasis (sCRLM).
  
  
  METHODS
  Using a multi-institutional database, we identified 1,004 patients treated for sCRLM between 1982 and 2011. Clinicopathologic and outcomes data were evaluated with uni- and multivariable analyses.
  
  
  RESULTS
  A simultaneous CRC and liver operation was performed in 329 (33%) patients; 675 (67%) underwent a staged approach ("classic" staged approach, n = 647; liver-first strategy, n = 28). Patients managed with the liver-first approach had more hepatic lesions and were more likely to have bilateral disease than those in the other 2 groups (p < 0.05). The use of staged operative strategies increased over the time of the study from 58% to 75% (p < 0.001). Liver-directed therapy included hepatectomy (90%) or combined resection + ablation (10%). A major resection (>3 segments) was more common with a staged approach (39% vs 24%; p < 0.001). Overall, 509 patients (50%) received chemotherapy in either the preoperative (22%) or adjuvant (28%) settings, with 11% of patients having both. There were 197 patients (20%) who had a complication in the postoperative period, with no difference in morbidity between staged and simultaneous groups or major vs minor hepatectomies (p > 0.05). Ninety-day postoperative mortality was 3.0%, with no difference between simultaneous and staged approaches (p = 0.94). The overall median and 5-year survivals were 50.9 months and 44%, respectively; long-term survival was the same regardless of the operative approach (p > 0.05).
  
  
  CONCLUSIONS
  Simultaneous and staged resections for sCRLM can be performed with comparable morbidity, mortality, and long-term oncologic outcomes.
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Skye C
authors: SC
authors: Mayo
authors: Carlo
authors: C
authors: Pulitano
authors: Hugo
authors: H
authors: Marques
authors: Jorge
authors: J
authors: Lamelas
authors: Christopher L
authors: CL
authors: Wolfgang
authors: Wassila
authors: W
authors: de Saussure
authors: Michael A
authors: MA
authors: Choti
authors: Isabelle
authors: I
authors: Gindrat
authors: Luca
authors: L
authors: Aldrighetti
authors: Eduardo
authors: E
authors: Barrosso
authors: Gilles
authors: G
authors: Mentha
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007391:International Cooperation; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged