title: Synchronous primary colorectal and liver metastasis: impact of operative approach on clinical outcomes and hospital charges.
abstract: OBJECTIVE
  The management of patients with colorectal cancer (CRC) and synchronous colorectal liver metastasis (CLM) remains controversial. The present study was conducted in order to assess the clinical and economic impacts of managing synchronous CLM with a staged versus a simultaneous surgery approach.
  
  
  METHODS
  A total of 224 patients treated for synchronous CLM during 1990-2012 were identified in the Johns Hopkins Hospital liver database. Data on clinicopathological features, perioperative outcomes and total hospital charges (inflation-adjusted) were collected and analysed.
  
  
  RESULTS
  Overall, 113 (50.4%) patients underwent staged surgery and 111 (49.6%) were submitted to a simultaneous CRC and liver operation. At surgery, liver-directed therapy included hepatectomy (75.0%) or combined resection and ablation (25.0%). Perioperative morbidity (30.0%) and mortality (1.3%) did not differ between groups (both P > 0.05). Median total length of hospitalization was longer in the staged (13 days) than the simultaneous (7 days) surgery group (P < 0.001). Median total hospital charges were higher among patients undergoing staged surgery (US$61,938) than among those undergoing a simultaneous operation (US$34,114) (P < 0.01). Median (simultaneous, 32.4 months versus staged, 39.6 months; P = 0.65) and 5-year (simultaneous, 27% versus staged, 29%; P = 0.60) overall survival were similar between groups.
  
  
  CONCLUSIONS
  Patients with synchronous CLM managed with either simultaneous or staged surgery have comparable perioperative and longterm outcomes. However, patients treated with simultaneous surgery spent an average of 6 days fewer in hospital, resulting in a reduction of median hospital charges of US$27,824 (55.1%). When appropriate and technically feasible, the simultaneous surgery approach to synchronous CLM should be preferred.
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Surgery, University of Illinois Hospital and Health Sciences Center, Chicago, IL, USA.
authors: Aslam
authors: A
authors: Ejaz
authors: Eugene
authors: E
authors: Semenov
authors: Gaya
authors: G
authors: Spolverato
authors: Yuhree
authors: Y
authors: Kim
authors: Dylan
authors: D
authors: Tanner
authors: John
authors: J
authors: Hundt
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D000368:Aged; D015142:Baltimore; D017115:Catheter Ablation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D003082:Colectomy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D015179:Colorectal Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000191:economics* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome