Simultaneous Colorectal and Hepatic Resections for Colorectal Cancer: Postoperative and Longterm Outcomes1

Santibañés, Eduardo de; Lassalle, Fernando Bonadeo; McCormack, Lucas; Pekolj, Juan; Quintana, Guillermo Ojea; Vaccaro, Carlos; Benati, Mario

doi:10.1016/s1072-7515(02)01235-8

Cited by 95 publications

(83 citation statements)

References 20 publications

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“…In recent years, however, advances in early diagnosis and surgical procedures appear to offer better long-term survival and cure in patients with limited CLM who are resectable, with a reported median survival of 35 -69 months. Large series report 5-year and 10-year survival rates as high as 51 and 27%, respectively, following hepatectomy in this setting (Scheele et al, 1995;Fong et al, 1999;Bolton and Fuhrman, 2000;Sugawara et al, 2001;Choti et al, 2002;de Santibanes et al, 2002;Adam et al, 2003).…”

mentioning

confidence: 99%

Predictors of survival after hepatic resection among patients with colorectal liver metastasis

et al. 2007

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Studies suggest improved survival following resection of colorectal cancer liver metastases (CLMs). We investigated predictors of survival among patients with CLM who underwent hepatic resection using the SEER-Medicare database to identify patients X65 years diagnosed with CLM, 1991CLM, -2003, who underwent hepatectomy. Cox proportional hazards models were used to identify factors associated with survival after hepatectomy. Of 923 patients with CLM who underwent hepatectomy, 514 were stages I -III and developed CLM46 months after diagnosis (metachronous), and 409 were stage IV with CLM at diagnosis (synchronous). From the date of hepatectomy, 5 year survival was 22%; younger age, being married, female gender, surgery in an NCI-designated cancer centre, fewer comorbidities, fewer positive lymph nodes, and lower grade were associated with improved survival. Both 5-fluorouracil (5FU)-based chemotherapy and hepatic arterial infusion (HAI) of floxuridine-based chemotherapy following hepatectomy improved survival (HR ¼ 0.62, 95% CI: 0.50 -0.78; HR ¼ 0.51, 95% CI: 0.28 -0.97, respectively) in the synchronous, but not metachronous, group. The HR for overall mortality was higher in hospitals with a high vs low procedure volume (0.75, 95% CI: 0.58 -0.94). A substantial subgroup of patients with CLM who undergo hepatectomy experiences long-term survival. High hospital procedure volume and use of 5FU-based or HAI-based chemotherapy after resection were associated with improved prognosis.

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confidence: 99%

Predictors of survival after hepatic resection among patients with colorectal liver metastasis

et al. 2007

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“…Existen varias estrategias para el tratamiento de las MHCRS: Clásicamente, se ha defendido la cirugía secuencial con resección del primario, quimioterapia y cirugía de las metástasis en pacientes con buena respuesta, ya que, aquellos sin respuesta a quimioterapia, tenían un mal pronóstico con o sin cirugía [13][14][15] . Actualmente se está cuestionando esa estrategia en favor de una cirugía simultánea que ofrece un solo ingreso con menor coste global, el paciente va menos inmunodeprimido y con menor toxicidad hepática a la cirugía y hay menos posibilidad de diseminación tumoral 5,7,12,16,17 . Además, las posibles complicaciones tras la resección colorrec tal podrían contribuir a retrasar el inicio de la quimioterapia y, por tanto, del abordaje de las MH en el caso de la cirugía secuencial 5 .…”

Section: Supervivenciaunclassified

“…Actualmente aumentan los grupos que optan por una cirugía simultánea del primario y de las metástasis si se cumplen algunas condiciones: que no haya enfermedad extrahepática; que las metástasis puedan ser resecadas por el mismo abordaje que el tumor primario; que se pueda hacer una resección R0 dejando un volumen aceptable de hígado sano; que el cirujano sea experto y que el paciente no presente comorbilidad importante 2,3 . Existen publicaciones en las que la morbimortalidad es mayor en la cirugía simultánea 4,5 , en tanto que otras obtienen resultados similares con ambas estrategias [5][6][7] . El objetivo de este trabajo es evaluar la morbimortalidad y supervivencia de los pacientes con MHCRS intervenidos de forma simultánea con el tumor primario y aquellos que fueron intervenidos de forma secuencial, previa quimioterapia.…”

Section: Introductionunclassified

Metástasis Hepáticas De Origen Colorrectal Sincrónicas: ¿intervención Simultánea O Secuencial?

et al. 2015

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simultaneous or sequential treatment of liver metastases of colon cancer? experience in 76 patientsBackground: Synchronous liver metastases of colon cancer can be managed with sequential or simultaneous surgical management of the primary tumor and the metastases. aim: To compare the evolution of patients whose liver metastases were treated sequentially or simultaneously. Material and Methods: Retrospective analysis of 76 patients aged 63 ± 11 years (67% males). In 25, metastases were managed simultaneously and in 51 there were treated sequentially after a period of chemotherapy. All interventions were performed by the same surgeon. results: Patients treated sequentially had a higher number of metastases and more lymph nodes involved than their counterparts treated simultaneously. The overall resectability index was 78%. Eighteen major and 28 minor hepatic resections were carried out. Significantly more major resections were carried out in the sequential treatment group. Mean hospital stay was 11 days and 20% of patients had complications, with no differences between groups. Survival at one, three and five years was 75, 45 and 36% in the simultaneous treatment and 76, 49 and 29% in the sequential treatment group (with no significant differences between groups). conclusions: In this group of patients no differences in complications or survival were observed when liver metastases were treated simultaneously or sequentially. However groups were not homogeneous.

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“…This is countered by the fact that a second admission for intra-abdominal surgery is not required. Additional studies have also shown that simultaneous resections are not associated with increased hepatic (perihepatic abscess due to translocation of intestinal bacteria or decreased hepatocyte regeneration) or colonic (increased incidence of anastamotic leakage) complications when compared against staged procedures (12,13,14) . However, excessive blood loss has been shown to have a deleterious effect on both short and long-term outcomes post hepatectomy (15) .…”

Section: Arguments Against Synchronous Resectionmentioning

confidence: 99%

“…Additionally, cases where the probability of postoperative liver insufficiency is increased (cirrhotics or patients in whom a major hepatectomy is being undertaken) should not undergo synchronous resection. Simultaneous hepatectomy should not be performed unless the chance of achieving a negative resection margin is high (10,14) .…”

Section: Recommendationsmentioning

confidence: 99%

Synchronous resection for colorectal liver metastases: The future

Pathak

Sarno

Nunes

et al. 2010

European Journal of Surgical Oncology

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Simultaneous Colorectal and Hepatic Resections for Colorectal Cancer: Postoperative and Longterm Outcomes1

Cited by 95 publications

References 20 publications

Predictors of survival after hepatic resection among patients with colorectal liver metastasis

Predictors of survival after hepatic resection among patients with colorectal liver metastasis

Metástasis Hepáticas De Origen Colorrectal Sincrónicas: ¿intervención Simultánea O Secuencial?

Synchronous resection for colorectal liver metastases: The future

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