Outcomes of Simultaneous Major Liver Resection and Colorectal Surgery for Colorectal Liver Metastases

Muangkaew, Paramin; Cho, Jai Young; Han, Ho‐Seong; Yoon, Yoo‐Seok; Choi, Yo Won; Jang, Jae Yool; Choi, Hanlim; Jang, Jae Seong; Kwon, Sun U.

doi:10.1007/s11605-015-2979-9

Cited by 43 publications

(36 citation statements)

References 45 publications

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“…This study was insufficiently powered, however, to make any conclusions regarding SR involving major hepatectomy. More recently, several investigators have reported that simultaneous major liver resections can be associated with results comparable with staged operations . Interestingly, in the present study, the vast majority (83.6%) of patients who underwent LSR had a minor liver resection (<3 segments) indicating that laparoscopy was considered suitable mostly for patients who did not require extensive hepatectomy.…”

Section: Discussionmentioning

confidence: 45%

Laparoscopic synchronous resection of colorectal cancer and liver metastases: A systematic review

Moris

Tsilimigras

Machairas

et al. 2018

Journal of Surgical Oncology

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While colorectal and hepatic resections are commonly performed through a laparoscopic approach, the safety and feasibility of total laparoscopic synchronous resections (LSR) of colorectal liver metastasis (CRLM) have not been established. In this systematic review, short-and long-term outcomes were comparable for patientsundergoing LSR and open synchronous resection. LSR was safe and feasible for patients with synchronous CRLM and should be considered in well-selected patients. K E Y W O R D S colorectal cancer, combined resection, laparoscopy, liver metastasis, synchronous resection 1 | INTRODUCTION Colorectal cancer (CRC) is the third leading cause of cancerrelated deaths in the United States. In 2017, approximately 140 000 new cases of CRC were diagnosed with over 50 000 cancer-related deaths. 1 The liver is the most common site of metastases with 15% to 25% of patients presenting with synchronous colorectal liver metastases (CRLM) at the time of diagnosis. 2,3 Modern chemotherapy has resulted in improved response and survival rates for patients with liver metastases and has also increased the rate of resectability of CRLM in selected patients as part of a comprehensive multidisciplinary treatment strategy. In turn, resection of CRLM is now associated with 5-year survival greater than 50%. 4,5Among patients with resectable disease, surgical resection remains the only potentially curative treatment for synchronous CRLM. 4 However, the optimal operative sequence for the management of the primary tumor and metastatic liver disease remains unclear. 6 The traditional surgical strategy consists of a staged approach, in which resection of the primary tumorwith or without adjuvant chemotherapyis followed by a planned liver resection at a future date (colorectal-first approach). Alternatively, the "reverse approach" consists of resection of liver metastases before removal of the primary tumor (liver-first approach). With improvements in surgical technique and perioperative care over the past two decades, an increasing number of patients are being managed through a combined approach comprised of synchronous resection of the primary colorectal tumor and liver metastases. 7,8 Several studies have demonstrated the safety, efficacy, and feasibility of open synchronous resections (OSR), with acceptable morbidity, mortality, and long-term outcomes. 7,9,10 Furthermore, synchronous resection (SR) may offer several potential benefits for patients, including shorter overall hospital LOS, reduced costs, and the need to recover from only one major operation, while providing equivalent oncologic outcomes. 11,12 J Surg Oncol. 2019;119:30-39. wileyonlinelibrary.com/journal/jso 30 |

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Section: Discussionmentioning

confidence: 45%

Laparoscopic synchronous resection of colorectal cancer and liver metastases: A systematic review

Moris

Tsilimigras

Machairas

et al. 2018

Journal of Surgical Oncology

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“…However, whether a simultaneous resection or a staged operation should be performed remains controversial. Several reports have shown that a staged operation is safer with fewer perioperative complications 141516. However, with development in surgical devices and techniques, pre- and post-operative management, and anesthetic techniques, safer and more aggressive liver resection operations are now possible17 and minimally invasive surgery for liver resection is now available for patients with CRLM.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of liver resection in patients with colorectal liver metastases by laparoscopic or open surgery

Shim

Lee

Park

et al. 2018

Ann Hepatobiliary Pancreat Surg

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Backgrounds/AimsColorectal cancer is found with liver metastases about 20–25% due to characteristics of cancer itself. Approximately 20% of liver metastases are found to be resectable. The objective of this study was to evaluate short-term outcomes of patients who received liver resection with colorectal cancer operation in our center by laparoscopic surgery or open surgery.MethodsShort-term outcomes of laparoscopic surgery of liver resection (LSLR) group who underwent liver resection for colorectal liver metastases (CRLM) at a single institute from 2013 to 2016 were compared to those of open surgery of liver resection (OSLR) group.ResultsA total of 123 patients underwent liver resection for CRLM, including 101 (82.1%) patients in the OSLR group and 22 (17.9%) patients in the LSLR group. There were significant differences in tumor characteristics between the two groups, including synchronous and metachronous (p=0.004), tumor number (p<0.001), and tumor margin (p=0.002). For postoperative outcomes, only the length of hospital stay (LOS) was significantly different between the two groups (8.5 days in LSLR vs. 11 days in OSLR, p<0.001). There was no significant difference in overall rate of postoperative complications between the two groups (9.1% in LSLR vs. 23.8% in OSLR, p=0.158).ConclusionsThere are no significant differences in postoperative outcomes between LSLR and OSLR except LOS, liver metastasis number, and resection margin. LSLR may be favorable for highly selected patients with CRLM.

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“…Additionally, the modest sample size of the cohort precludes an indepth analysis of the long-term oncological outcomes following simultaneous versus two-staged resection of colorectal cancer and associated liver metastases; however this question has been addressed in large meta-analyses, with no significant differences in survival identified (30)(31)(32). Furthermore, while simultaneous colorectal resection and major liver resection should be approached with caution, it has been performed safely in experienced centers (33)(34)(35) and may be considered in order to minimize the number of surgeries and overall length of treatment. While we did not have access to complete data on total treatment time for patients who had the colon portion of their staged procedure performed outside of our local area, we suspect that total time spent receiving treatment may be shorter for synchronous resections.…”

Section: Discussionmentioning

confidence: 99%

Management of colorectal cancer with synchronous liver metastases: impact of multidisciplinary case conference review

Wanis¹,

Pineda-Solís²,

Tun-Abraham³

et al. 2017

Hepatobiliary Surg. Nutr.

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Background: While no evidence exists to support mandatory multidisciplinary case conference (MCC) review for patients with synchronous colorectal cancer and liver metastases, this unique population may benefit greatly from multidisciplinary discussion. Methods:We retrospectively identified patients who underwent liver resection with curative intent for colorectal liver metastases (CRLM) at a tertiary center between January 2008 and June 2015. The characteristics of patients discussed at a weekly regional MCC were examined, and the effect of MCC review on treatment approach was assessed.Results: Sixty-six patients underwent elective surgery for synchronous colorectal cancer and liver metastases during the study period. Twenty-nine patients (44%) were presented at a MCC. Presentation was associated with greater likelihood of undergoing simultaneous or liver-first resection (P≤0.0001), with no difference in the extent of liver resection or location of primary tumor between the groups. A greater proportion of patients received chemotherapy and/or radiation following MCC discussion, without statistical significance. Conclusions:The treatment approach for patients with synchronous colorectal cancer and liver metastases may be significantly altered based on MCC review. Multidisciplinary discussion is advocated in order to facilitate equal access to individualized care.

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Outcomes of Simultaneous Major Liver Resection and Colorectal Surgery for Colorectal Liver Metastases

Abstract: Simultaneous MLR is feasible and safe in synchronous CRLM patients, including rectal cancer patients.

Cited by 43 publications

References 45 publications

Laparoscopic synchronous resection of colorectal cancer and liver metastases: A systematic review

Laparoscopic synchronous resection of colorectal cancer and liver metastases: A systematic review

Outcomes of liver resection in patients with colorectal liver metastases by laparoscopic or open surgery

Management of colorectal cancer with synchronous liver metastases: impact of multidisciplinary case conference review

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