Simultaneous Versus Staged Resection for Synchronous Colorectal Cancer Liver Metastases

Martin, Robert C.G.; Augenstein, Vedra A.; Reuter, Nathaniel P.; Scoggins, Charles R.; McMasters, Kelly M.

doi:10.1016/j.jamcollsurg.2009.01.031

Cited by 171 publications

(104 citation statements)

References 36 publications

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“…Los 4 pacientes a los que sólo les realizamos una laparotomía exploradora, no fueron incluidos en el análisis de supervivencia entendiendo que, realmente, no se había realizado ningún gesto quirúrgico sobre las MH, pero sí en el resto de parámetros descriptivos por entender que la laparotomía exploradora ya es en sí misma una intervención que puede conllevar morbi-mortalidad. en tanto que otros incluyen las que aparecen hasta 12 meses después, entendiendo que pasaron desapercibidas en el diagnóstico del tumor primario 12 . nosotros las hemos definido como aquellas diagnosticadas antes o durante la intervención del primario, para poder comparar dos grupos más homogéneos como opinan otros autores 11 .…”

Section: Supervivenciaunclassified

“…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

“…Los dos grupos son homogéneos en cuanto a edad, sexo, localización y riesgo anestésico (ASA) y similares a los de otras series 12,20,22 . El número de MH fue mayor en el grupo 2, algo esperable, ya que la cirugía simultánea la realizamos sólo en casos de 3 o menos metástasis hepáticas tal y como recomiendan la mayoría de los autores 12,21,23,24 .…”

Section: Supervivenciaunclassified

“…El número de MH fue mayor en el grupo 2, algo esperable, ya que la cirugía simultánea la realizamos sólo en casos de 3 o menos metástasis hepáticas tal y como recomiendan la mayoría de los autores 12,21,23,24 . Por el mismo motivo el índice de resecabilidad fue mayor en el grupo 1 así como el porcentaje de resecciones hepáticas aunque sin significación estadística.…”

Section: Supervivenciaunclassified

“…El índice de resecabilidad global fue de 77,6%, menor que en otras series de nuestro entorno y tal vez por eso, unido a que las intervenciones hepáticas fueron realizadas por el mismo cirujano, la morbilidad global es menor y no hemos tenido complicaciones mayores ni diferencias entre ambos grupos 4,7,12,15,[21][22][23]27,28 (Tabla 3), a pesar de que tenemos 46 pacientes ASA 3, por lo que no creemos que el status preoperatorio deba influir para elegir una u otra estrategia.…”

Section: Supervivenciaunclassified

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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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Section: Supervivenciaunclassified

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

et al. 2015

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Systematic review of surgical management of synchronous colorectal liver metastases

Lykoudis

O’Reilly

Nastos

et al. 2014

British Journal of Surgery

108

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Timing of hepatectomy in resectable synchronous colorectal liver metastases (SCRLM): Simultaneous or delayed?

et al. 2013

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The optimal surgical strategy for treatment of patients with synchronous colorectal liver metastases (SCLRM) remains controversial. We conducted a systematic review and metaanalysis of all observational studies to define the safety and efficacy of simultaneous versus delayed resection of the colon and liver. A search for all major databases and relevant journals from inception to April 2012 without restriction on languages or regions was performed. Outcome measures were the primary parameters of postoperative survival, complication, and mortality, as well as other parameters of blood loss, operative time, and length of hospitalization. The test of heterogeneity was performed with the Q statistic. A total of 2,880 patients were included in the meta-analysis. Long-term oncological pooled estimates of overall survival (hazard ratio [HR]: 0.96; 95% confidence interval [CI]: 0.81-1.14; P 5 0.64; I 2 5 0) and recurrence-free survival (HR: 1.04; 95% CI: 0.76-1.43; P 5 0.79; I 2 5 53%) all showed similar outcomes for both simultaneous and delayed resections. A lower incidence of postoperative complication was attributed to the simultaneous group as opposed to that in the delayed group (modified relative ratio [RR] 5 0.77; 95% CI: 0.67-0.89; P 5 0.0002; I 2 5 10%), whereas in terms of mortality within the postoperative 60 days no statistical difference was detected (RR 5 1.12; 95% CI: 0.61-2.08; P 5 0.71; I 2 5 32%). Finally, selection criteria were recommended for SCRLM patients suitable for a simultaneous resection. Conclusion: Simultaneous resection is as efficient as a delayed procedure for long-term survival. There is evidence that in SCRLM patients simultaneous resection is an acceptable and safe option with carefully selected conditions. Due to the inherent limitations of the present study, future randomized controlled trials will be useful to confirm this conclusion. (HEPATOLOGY 2013;57:2346-2357 C olorectal cancer (CRC) remains the second leading cause of cancer-related death in Western Europe and North America, and there are more than 940,000 new cases annually and nearly 500,000 deaths each year worldwide. [1][2][3] Up to 50% of patients with CRC might have liver metastases during the course of the disease, and 15% to 20% have synchronous colorectal liver metastases (SCRLM) at the time of diagnosis, whereas an additional 20% to 25% develop metachronous hepatic tumors. [4][5][6][7] The presence of liver metastases has an important influence on patient prognosis, and the median survival is 2.3 to 21.3 months for patients in whom the cancer is nonresected. 3,5,[8][9][10] Furthermore, liver resection has been accepted as the only treatment offering the chance for a cure and long-term survival, with 5-year survival rates of 25% to 60% and 10-year survival rates of 22% to 26% reported in the literature. [11][12][13][14][15][16][17][18][19] However, optimal timing of liver surgery for synchronous metastases remains controversial and continues to evolve. 20 Previously, most series reporting on the surgical management ...

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Simultaneous Versus Staged Resection for Synchronous Colorectal Cancer Liver Metastases

Cited by 171 publications

References 36 publications

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

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

Systematic review of surgical management of synchronous colorectal liver metastases

Timing of hepatectomy in resectable synchronous colorectal liver metastases (SCRLM): Simultaneous or delayed?

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