Simultaneous resection of synchronous colorectal liver metastasis: Feasibility and development of a prediction model

Abstract

Backgrounds/Aims: Timing of resection for synchronous colorectal liver metastasis (CRLM) has been debated for decades. The aim of the present study was to assess the feasibility of simultaneous resection of CRLM in terms of major complications and develop a prediction model for safe resections. Methods: A retrospective single-center study of synchronous, resectable CRLM, operated between 2013 and 2021 was conducted. Upper limit of 95% confidence interval (CI) of major complications (≥ grade IIIA) was set at 40% as the safety threshold. Logistic regression was used to determine predictors of morbidity. Prediction model was internally validated by bootstrap estimates, Harrell's C-index, and correlation of predicted and observed estimates. Results: Ninety-two patients were operated. Of them, 41.3% had rectal cancers. Major hepatectomy (≥ 4 segments) was performed for 25 patients (27.2%). Major complications occurred in 20 patients (21.7%, 95% CI: 13.8%-31.5%). Predictors of complications were the presence of comorbidities and major hepatectomy (area under the ROC curve: 0.692). Unacceptable level of morbidity (≥ 40%) was encountered in patients with comorbidities who underwent major hepatectomy. Conclusions: Simultaneous bowel and CRLM resection appear to be safe. However, caution should be exercised when combining major liver resections with bowel resection in patients with comorbid conditions.

Propensity-score matched outcomes of resection of stage IV primary colon cancer with and without simultaneous resection of liver metastases

“…Reddy et al [ 13 ] reported that simultaneous colorectal resection and minor liver resection did not significantly increase the overall morbidity and mortality, and, conversely, simultaneous colorectal and major hepatic resections were associated with an increased risk of severe morbidity. Similarly, in a retrospective study [ 14 ] on 92 patients with synchronous resectable CLM, 27% of whom underwent major liver resection of ≥ 4 segments, the rate of major complications was 21.7%. The significant predictors of complications were medical comorbidities and major hepatectomy, which increased the complication rate to 40%.…”

Staged or Simultaneous Surgery for Colon or Rectal Cancer with Synchronous Liver Metastases: Implications for Study Design and Clinical Endpoints

“…When it comes to choosing the optimal surgical strategy for resection of the primary tumor and synchronous liver metastases, the jury is still out. The data available ( Figure 1 ) are scarce to justify any one strategy over the other and are insufficient for use of open or minimally invasive surgery [ 12 , 14 , 15 , 16 , 17 ]. At present, there is only one prospective randomized trial (METASYNC) that has examined simultaneous and staged resection of CRC with synchronous liver metastases [ 18 ].…”

Laparoscopic liver metastasectomy, retroperitoneal lymph node dissection and abdominoperineal resection for rectal cancer

“…Colorectal cancers with liver metastases are common and associated with relatively favourable prognoses 1 . However, retroperitoneal lymph node metastases are less frequently observed and are correlated with poor outcomes 2 .…”

“…Colorectal cancers with liver metastases are common and associated with relatively favourable prognoses. 1 However, retroperitoneal lymph node metastases are less frequently observed and are correlated with poor outcomes. 2 Even though synchronous colorectal cancers and liver metastases are operated upon simultaneously and by minimally invasive approaches, retroperitoneal lymph node dissections are still a regular indication for open operations.…”