title: What is the Optimal Timing for Liver Surgery of Resectable Synchronous Liver Metastases from Colorectal Cancer?
abstract: The optimal timing of the surgical strategy for colorectal cancer (CRC) presenting with resectable synchronous liver metastases remains unclear and controversial. The aim of this study was to compare simultaneous with staged resection, with respect to morbidity, mortality, and prognosis, including recurrence. A total of 107 patients who underwent initial hepatic resection for resectable synchronous liver metastasis from colorectal cancer were retrospectively analyzed. The 5-year disease-free survival rates were 16.4 per cent in the simultaneous group, and 24.0 per cent in the staged group (P = 0.5486). The 5-year overall survival rates were 70.7 per cent in the simultaneous group and 67.9 per cent in the staged group (P = 0.8254). Perioperative chemotherapy did not have a significant effect. Tumor depth of CRC (≥pT4) was the only key factor influencing prognosis. Postoperative intestinal anastomotic leakage occurred in nine patients (8.4%). On multivariate analysis, simultaneous surgery was shown to be the only independent risk factor for the occurrence of postoperative intestinal anastomotic leakage (P = 0.0163). In conclusion, neither timing of hepatic resection (simultaneous or staged) nor perioperative chemotherapy represented significant prognostic factors. The simultaneous surgery was the only independent risk factor for intestinal anastomotic leakage. Therefore, we recommend staged hepatic surgery for synchronous CRC and liver metastasis from colorectal cancer.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inoue
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Imai
authors.forename: Wataru
authors.initials: W
authors.lastname: Osumi
authors.forename: Tetsunosuke
authors.initials: T
authors.lastname: Shimizu
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Asakuma
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Hirokawa
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D057868:Anastomotic Leak / Q000209:etiology*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003110:Colonic Neoplasms / Q000473:pathology; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents