Outcomes of simultaneous resections for patients with synchronous colorectal liver metastases.
BACKGROUND
The aim of this study was to determine the outcomes associated with simultaneous resections compared to patients undergoing sequential resections for synchronous colorectal liver metastases.


METHODS
Consecutive patients undergoing hepatic resections between 2000 and 2012 for synchronous colorectal liver metastases were identified from a prospectively maintained database.


RESULTS
Of the 112 hepatic resections that were performed, 36 were simultaneous resections and 76 were sequential resections. There was no difference in disease severity: number of metastases (P 0.228), metastatic size (P 0.58), the primary tumour nodal status (P 0.283), CEA (P 0.387) or the presence of extra-hepatic metastases (P 1.0). Major hepatic resections were performed in 23 (64%) and 60 (79%) of patients in the simultaneous and sequential groups respectively (P 0.089). Intra-operatively no differences were found in blood loss (P 1.0), duration of surgery (P 0.284) or number of adverse events (P 1.0). There were no differences in post-operative complications (P 0.161) or post-operative mortality (P 0.241). The length of hospital stay was 14 (95% CI 12.0-18.0) and 18.5 (95% CI 16.0-23.0) days in the simultaneous and sequential groups respectively (P 0.03). The 3-year overall survival was 75% and 64% in the simultaneous and sequential groups respectively (P 0.379). The 3-year hepatic recurrence free survival was 61% and 46% in the simultaneous and sequential groups respectively (P 0.254).


CONCLUSIONS
Simultaneous resections result in similar short-term and long-term outcomes as patients receiving sequential resections with comparable metastatic disease and are associated with a significant reduction in the length of stay.
Division of Surgery and Cancer, Imperial College, Chelsea and Westminster Campus, Fulham Road, London, UK; Department of Colorectal Surgery, The Royal Marsden Hospital, UK. Electronic address: alistairslesser@hotmail.com.
A A P
AA
Slesser
M
M
Chand
R
R
Goldin
G
G
Brown
P P
PP
Tekkis
S
S
Mudan
D000368:Aged; D016063:Blood Loss, Surgical; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D047368:Tumor Burden
Colorectal cancer; Sequential resections; Simultaneous resections; Synchronous colorectal liver metastases