title: Defining an optimal surgical strategy for synchronous colorectal liver metastases: staged versus simultaneous resection?
abstract: BACKGROUND
  We aimed to assess if simultaneous resection conferred any survival benefit in resection of synchronous colorectal liver metastases.
  
  
  METHODS
  From January 1990 to December 2008, 116 patients with synchronous colorectal liver metastases were identified. Among these 116 patients, 88 underwent staged resection (SR), while the remaining 28 patients underwent simultaneous resection (SIMR). Patients' follow-up data were reviewed.
  
  
  RESULTS
  There were no significant differences between the groups in terms of patient and tumour characteristics. Major hepatectomy was performed in 54 patients (61%) undergoing SR, and 12 patients (43%) undergoing SIMR (P = 0.09). The median blood loss (SR 0.7 L versus SIMR 0.8 L) was similar. Post-operative morbidity rates and hospital mortality rates were not statistically different. The total length of hospital stay was shorter in SIMR patients (18.0 versus 11.5 days, P = 0.009). The 1-, 3- and 5-year overall survival for SR were 90.7%, 47.1% and 33.3%, whilst the corresponding survival rates for SIMR were 75.0%, 25.0% and 0%, respectively (P = 0.003). However, when the disease-free survival (DFS) was stratified according to the number of hepatic metastases, the survival benefit of SR and SIMR for solitary CRM were similar (3-year DFS: 28.3% versus 11.1%, P = 0.089).
  
  
  CONCLUSIONS
  Our study showed that an operative strategy of SR generally offered better survival outcome than SIMR in the surgical management of CRM.
authors: Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong.
authors: Wong Hoi
authors: WH
authors: She
authors: Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong.
authors: Albert Chi Yan
authors: AC
authors: Chan
authors: Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong.|State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong.
authors: Ronnie Tung Ping
authors: RT
authors: Poon
authors: Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong.
authors: Tan To
authors: TT
authors: Cheung
authors: Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong.
authors: Kenneth Siu Ho
authors: KS
authors: Chok
authors: Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong.|State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong.
authors: See Ching
authors: SC
authors: Chan
authors: Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong.|State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong.
authors: Chung Mau
authors: CM
authors: Lo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
keywords: simultaneous resection; stage resection; synchronous colorectal liver metastasis