Simultaneous Hepatectomy as a Safe Approach for Synchronous Colorectal Liver Metastasis

Abstract

Objective: The optimal surgical strategy for treatment of colorectal cancer with synchronous liver metastasis remains controversial. This retrospective analysis compared both surgical and perioperative outcomes for patients receiving simultaneous hepatectomy and primary colorectal surgery, to those receiving hepatectomy alone for stage approach. Material and Methods: Between; June, 2013 and June, 2019, 111 patients underwent a hepatectomy for synchronous liver metastasis, from this 90 patients received stage resection (hepatectomy alone group), and 21 patients received simultaneous resection (simultaneous resection group) with primary colorectal cancer. Results:There were no significant differences in gender, age, primary tumor location, tumor size, number of liver metastasis, estimated blood loss, nor rate of blood transfusion. However, the hepatectomy alone group was significantly higher in the proportion of preoperative chemotherapy, compared to the simultaneous resection group (93.3 vs. 38.1%, respectively; p-value<0.001). Additionally, total operative time in the simultaneous resection group was significantly longer, when compared to the hepatectomy alone group (530 vs. 300 minutes, respectively; p-value<0.001). The length of hospital stay was also longer in the simultaneous resection group, compared to the hepatectomy alone group (10 days vs. 7 days, respectively; p-value<0.001). However, the rate of major postoperative complications were similar (14.3 vs. 10.0%; p value=0.525), respectively. Additionally, major hepatectomy and simultaneous resection were not significantly associated with any major complications. Conclusion: Simultaneous hepatectomy in synchronous colorectal liver metastasis is a safe approach, and does not increase the risks of major complications.

Perioperative Outcomes of Laparoscopic Liver Resection and Risk Factors for Adverse Events

“…Regarding the length of stay (LOS), the overall median LOS was 5 days, and the median LOS values of patients with and without AEs were 7 and 5 days, respectively. In our previous study on colorectal liver metastasis, the group of patients represented open surgery; the median LOS was 7 days25 and seemed longer than the present laparoscopic liver surgery study consisted with the evidence from a meta-analysis indicated that LLR had a shorter LOS than open surgery 4. However, in the present study, the benefit of LLR in terms of faster recovery time is preserved only in patients who did not experience AEs.…”

Safety and long-term prognosis of simultaneous versus staged resection in synchronous colorectal cancer with liver metastasis: a systematic review and meta-analysis

“…Total hospital stay was reported in 14 articles and the heterogeneity substantially decreased (from 94.3% to 76.9%) after excluding one publication[ 40 ] and thus 13 publications were included in the pooled analysis. The average total hospital stay was five days shorter in the simultaneous resection than in the staged-resection group (WMD = –5.43, 95% CI [− 7.29 to − 3.58], P < 0.001; I 2 = 76.9%; Fig.…”

“…1). In total, only 1 RCT [22] and 22 nRCTs [13,14,17,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41], comprising a total of 4862 patients (2056 and 2806 cases of simultaneous resection and staged resection, respectively) were included. All the nRCTs had a NOS score ≥ 6 and the RCT had a low bias risk, assessed using RevMan 5.3 (Fig.…”